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OKLAHOMA
Mental Health Block Grant
Plan & Application
Public Comment on 2009-2011 Mental Health Block Grant Plan
This current application will be submitted in a format required by the Center for
Mental Health Services on September 1, 2010. Public comments are
requested in response to this proposed plan as described below.
1. Throughout the year, the Oklahoma Mental Health Planning and Advisory
Council (MHPAC) meets in accordance with Oklahoma’s Open Meetings
Act. Each meeting includes time for public comment on the Mental Health
Block Grant Plan for Oklahoma. Comments are summarized in Council
minutes and utilized by the MHPAC and the state throughout the year.
2. A draft of this enclosed application will be reviewed in detail at an open
meeting of the MHPAC on August 12, 2010, 10:00 am to noon in the
ODMHSAS Central Office in Oklahoma City. All present at the meeting –
including members of the public who do not serve on the MHPAC – will be
provided time to offer comments to the state and the MHPAC related to the
proposed application.
3. Oklahoma is currently operating under an approved 3-year Mental Health
Block Grant plan for FFY2009-2011. FY2011 Updates to that plan are
included in this document and are noted in the following pages as
“FFY2011 Application Updates”. To offer written comments on the
proposed application update or for additional information please contact
John Hudgens, P.O. Box 53277, Oklahoma City, OK 73152,
jhudgens@odmhsas.org or (405) 522-3800.
Formal public input will be accepted, for consideration within this application
cycle, through August 23, 2010.
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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OKLAHOMA
Mental Health Block Grant
Plan & Application
2009 – 2011
Submitted September 2008
UPDATES SUBMITTED SEPTEMBER 2009 AND SEPTEMBER 2010
DRAFT for Public Comment – August 4, 2010
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
3
TABLE OF CONTENTS
INTRODUCTION 4
OKLAHOMA MENTAL HEALTH PLANNING AND ADVISORY COUNCIL OVERVIEW 4
SUMMARY OF RECENT ACTIVITIES 5
DESCRIPTION OF STATE SERVICE SYSTEM 7
FIGURE 1. 7
OTHER NEW DEVELOPMENTS – SERVICES ACROSS THE LIFESPAN 10
SYSTEM STRENGTHS, NEEDS, AND PRIORITIES 15
PEER AND FAMILY ADVOCACY 17
SYSTEM STRENGTHS, NEEDS, AND PRIORITIES - CONTINUED 22
CHILDREN 22
EXEMPLARY TREATMENT FOR CHILDREN 24
STATE MENTAL HEALTH PLAN 27
ADULT PLAN – DESCRIPTION OF SERVICES 27
CRITERION 1 (ADULT PLAN): COMPREHENSIVE COMMUNITY-BASED SYSTEM OF CARE FOR ADULTS 27
CRITERION 2 (ADULT PLAN): MENTAL HEALTH EPIDEMIOLOGY DATA 31
CRITERION 3. (NOT APPLICABLE TO ADULT PLAN) 32
CRITERION 4 (ADULT PLAN): TARGET POPULATIONS 32
OTHER HOMELESS SERVICES 32
CRITERION 5 (ADULT PLAN): MANAGEMENT SYSTEMS 34
PERFORMANCE GOALS, TARGETS, AND ACTION PLANS – ADULT PLAN 38
TRANSFORMATION ACTIVITIES - ADULT PLAN 41
SUMMARY OF SELECTED TRANSFORMATION ACTIVITIES – ADULT PLAN 43
STATE MENTAL HEALTH PLAN 45
CHILD PLAN – DESCRIPTION OF SERVICES 45
CRITERION 1 (CHILD PLAN) : COMPREHENSIVE COMMUNITY-BASED SYSTEM OF CARE FOR CHILDREN. 45
CRITERION 2 (CHILD PLAN): MENTAL HEALTH EPIDEMIOLOGY DATA 47
CRITERION 5 (CHILD PLAN): MANAGEMENT SYSTEMS 52
PERFORMANCE GOALS, TARGETS, AND ACTION PLANS – CHILD PLAN 55
TRANSFORMATION ACTIVITIES – CHILD PLAN 57
SUMMARY OF SELECTED TRANSFORMATION ACTIVITIES – CHILD PLAN 57
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011
Introduction
This Mental Health Block Grant Application and Plan has been prepared on behalf of the State of Oklahoma
in accordance with Part B of Title XIX of the Public Health Service Act. The Substance Abuse and Mental
Health Services Administration (SAMHSA) administers the grant program through the Center for Mental
Health Services. This specific block grant program supports existing public services and encourages the
development of creative and cost-effective systems of community-based care for people with serious mental
disorders. This application has been prepared in a format for public review and comment. Instructions
appear at the end of the document to guide readers in submitting comments upon their review of the
document. This particular document is organized as a 3-year plan and must be submitted to SAMHSA by
September 2, 2008.
The plan includes introductory information on the role of the Oklahoma Mental Health Planning and Advisory
Council. The actual plan is organized around key topics describing the state’s service system, including
strengths, needs, and priorities; actions proposed to continue with service improvement – including
transformation activities underway; and, targeted measures to document the state’s achievement of the
goals proposed in this plan. Content specific to adults and to children and their families is identified
throughout the document.
Readers are encouraged to review this plan with the understanding that the intent of the Mental Health Block
Grant program is to support statewide improvement, innovation, and inclusion on behalf of adults and
children in need of mental health, substance abuse, and prevention services. The Mental Health Block Grant
Plan provides a basis for future changes and is organized in a manner to accommodate annual updates and
revisions. In addition to the Mental Health Block Grant, Oklahoma is also a recipient of a Transformation
State Incentive Grant (TSIG) (see www.OkInnovationCenter.org). The state views the two federal initiatives
as complementary and has proposed this Block Grant Plan and Application in a manner to honor the value
both programs bring to Oklahoma.
Oklahoma’s vision for transformation is that all our citizens will prosper and achieve their personal goals in
the communities of their choice. This document has been developed with that vision clearly in sight.
FFY2010 Application Updates: The original plan submitted on September 1, 2008 received a 3-year
approval by CMHS without modification. This September 2009 document includes the narrative upon which
that 3-year approval was granted as well as updates to accompany Oklahoma’s application for FFY2010
funding.
FFY2011 Application Updates: This September 2010 document includes the narrative upon which that 3-
year approval was granted as well as updates to accompany Oklahoma’s application for FFY2011 funding.
Oklahoma Mental Health Planning and Advisory Council Overview
Council Duties. The Oklahoma Mental Health Planning and Advisory Council’s purpose is to (1) Review
plans, including the Federal Mental Health Services Block Grant Plan provided to the Council, and to submit
to the state any recommendations of the Council for modifications to the plans; (2) serve as an advocate in
promoting an enhanced quality of life for all adults with serious mental illness, children with an emotional
disturbance and their families, and other individuals with mental illness or emotional problems; (3) monitor,
review, and evaluate, not less than once each year, the allocation and adequacy of mental health services
within the state; and, (4) exchange information and develop, evaluate, and communicate ideas about mental
health planning and services.
Council Membership. The Council consists of no more than 35 members and is comprised of Oklahoma
residents that includes representatives of (1) principal state agencies involved in mental health and related
support services; (2) public and private entities concerned with the need, planning, operation, funding, and
use of mental health services and related support activities; (3) adults with serious mental illnesses who are
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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receiving, or have received mental health services; (4) the families of such adults; and, (5) families of
children with emotional disturbances.
Directors of the following state agencies appoint one member each to the Council: Oklahoma Health Care
Authority; Oklahoma Department of Rehabilitation Services; Oklahoma State Department of Education;
Oklahoma Department of Corrections; Oklahoma Office of Juvenile Affairs; Oklahoma State Department of
Health; Oklahoma Housing Finance Agency; and Oklahoma Department of Human Services.
The ODMHSAS Commissioner appoints two staff representatives, one representing mental health and one
representing substance abuse services. Boards of Directors of the following statewide advocacy
organizations also appoint one person each to serve as a Council member: National Alliance on Mental
Illness – Oklahoma; Oklahoma Mental Health Consumer Council; Oklahoma Federation of Families; and
Depression and Bipolar Support Alliance of Oklahoma.
The Commissioner of the Oklahoma Department of Mental Health and Substance Abuse Services, with
recommendations from the Council, appoints all remaining members of the Council including consumers of
mental health services, family members of adults with serious mental illnesses receiving services, family
members of children with serious emotional disturbances, providers, advocates, and other individuals
interested in the quality and effectiveness of mental health services.
Membership Terms. State agencies have permanent membership. Appointments are at the discretion of
each agency Director. Statewide advocacy organizations designated in Council Bylaws also have
permanent membership, with designees serving at the discretion of their Boards of Directors, to be verified to
the Council secretary by January 1 of each year. All other members, including consumers, family members
of consumers, and family members of children with serious emotional disorders (SED), consumer advocates,
and providers are appointed for one three-year term, with the option of a second three-year term. They can
be eligible for membership on the Council again after a 1-year break following the second three-year term.
Council Meetings. Regular meetings of the Council are held no less than quarterly. The Council typically
conducts six meetings each year. The Executive Committee may call special meetings at the request of a
majority of the members of the Council. All meetings of the Council are open to the public. Time is set aside
at all meetings of the Council for members of the public to address the Council. All meetings are announced
and posted in accordance with state open meetings law.
Summary of Recent Activities
• The Council continued to focus membership diversity in 2008. The Membership Committee, under
the direction of the Council, solicited recommendations and successfully recruited new members to
increase racial, ethnic, age, and cultural diversity as well as expanded the geographic representation
on the Council. In 2008, the Council also increased representation of parents and advocates who
speak on behalf of children with serious emotional disturbance and their families.
• The Center for Mental Health Services (CMHS) completed a site visit in June 2008, to monitor the
state’s compliance with Mental Health Block Grant requirements. During that visit, considerable time
was spent with the Council to review the Council’s functions, identify priorities of the Council, and
determine additional avenues by which the Council can impact the policy and direction of mental
health and substance abuse services in the state.
• The Council continues to have a specific representative appointed to the Governor’s Transformation
Advisory Board (GTAB) which is Oklahoma’s Transformation Working Group (TWG) as required by the
CMHS Transformation State Incentive Grant (TSIG). Other members of the GTAB are also Council
members.
• Two Council members participated in the 2008 National Joint Conference for the Mental Health Block
Grant and Statistics.
• Advocacy issues are identified by Council members and included for open discussion and fact finding
on Council agendas. Frequently, the Council will request additional information and propose actions
to proactively address the issues of concern. At the Council’s request the following items were
included as agenda presentations throughout the year. These provided opportunities for Council
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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members to offer suggestions, advocate for specific issues, and recommend actions to the presenters.
Advocacy issues included:
o Department of Public Safety policy regarding driver’s licenses applications (related to
persons who received treatment for a mental disorder)
o Disaster response planning
o Interagency planning and implementations related to children’s services
o Department of Corrections/adult mental health services
o Transformation updates related to the State Incentive Grant
o Peer Recovery Support Services
• The Council utilized technical assistance provided in 2007 by the National Association of Mental
Health Planning and Advisory Councils (NAMHPAC) to determine how Council priorities could be more
actively addressed through the formation of workgroups. For 2008, the following workgroups are in
place: Adult Services, Children’s Services, Older Adults Services, and Veterans Issues. In addition
the Council utilizes its Executive Committee and a Legislative Committee to assist the Council to
perform its advocacy and planning responsibilities.
• Monitoring responsibilities of the Council are frequently performed by the entire Council. The Council
identifies specific mental health and substance abuse program activities for monitoring. Specific or
representative program administrators and providers are scheduled for presentations to the Council at
regular meetings. These reports and related advocacy or other follow up activities are noted in the
Council minutes. It is anticipated, however, the above referenced workgroups will provide an additional
infrastructure through which the Council can perform monitoring. The CMHS site visit monitors
consulted with the Council in June 2008 and provided additional suggestions to the Council in terms of
the monitoring activities.
FFY2010 Application Updates: During FY2009, the Council remained active addressing its mandated
responsibilities, including additional emphasis on monitoring. The Council worked with the Deputy
Commissioner for Mental Health Services to schedule regular presentations by programs receiving MHBG
funds. Typically, a specific program was featured at each Council meeting. New members were appointed
to the Council and those new members assisted the Council in its ongoing goal to expand geographic,
cultural, and age representation on the Council, including a new youth member. The incoming Council
Chair and one other member of the Executive Committee attended the Annual CMHS MHBG/Data
Conference, June 2009 in Washington, DC.
FFY2011 Application Updates: The Council continued to fulfill all responsibilities in FY2010 related to
advocacy, planning, and monitoring. Key ODMHSAS staff participated regularly in Council meetings and
provided information and requests for guidance from the Council. Regular participants included the Deputy
Commissioner for Mental Health Services, the Director of Community Based Services (responsible for both
the child and adult systems of care), and the Director of Advocacy and Wellness. Additionally, ODMHSAS
Commissioner and Cabinet Secretary for Health, Terri White, addressed the Council, provided regular
updates to the Council through other ODMHSAS staff, and reported Council activities to the ODMHSAS
Governing Board.
The MHPAC also participated with the Coalition of Advocates on legislative, policy, and funding issues. The
Council maintained active representation on the Governor’s Transformation Advisory Board that works with
the Innovation Center in the implementation of the SAMSHA Transformation State Incentive Grant.
As in recent years, new members appointed to the Council further expanded representation, including
additional members from Tribal nations and youth representatives.
Specific to monitoring, the Council scheduled agenda items at each of its meetings during which
representatives of programs receiving MHBG funds provided updates to the members and on other initiatives
underway that enhance the broader system of care for children and adults.
The Council Chair and one other Council member attended the Annual CMHS MHBG/Data Conference,
June 1010 in Washington, DC
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
7
Description of State Service System
Overview. The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) was
established through the Mental Health Law of 1953. The law provides that all residents in the state are
entitled to care and treatment for mental illness and addiction problems in accordance with appropriate
standards of care. An eleven-member board appointed by the Governor oversees agency operations. The
Commissioner is appointed by the governing board and serves as chief executive officer. The Central Office
of the ODMHSAS is in Oklahoma City and provides the administrative, coordinating, and planning functions
of the statewide system. The ODMHSAS is the designated state authority for mental health and substance
abuse services. The mission of the ODMHSAS is to promote healthy communities and provide the highest
quality of care to enhance the well being of all Oklahomans. The ODMHSAS vision is that services will
promote productive lifestyles and set the national standard for prevention, treatment, and recovery for those
affected by mental illness and substance abuse disorders.
Delivery System. The core of the system is a network of 15 community mental health centers (CMHCs).
Ten are nonprofit agencies with which the ODMHSAS contracts and five are state-operated centers. The
state is geographically divided into 17 service areas; each served by a community mental health center (see
Figure 1.) One center serves three areas. Each CMHC is responsible to assure access to a comprehensive
array of services within a designated service area. However, individuals seeking services, in general, may
choose to seek services out of the service area in which they reside. CMHCs operate approximately 70
offices geographically dispersed throughout the state.
The ODMHSAS operates two state hospitals for adults and one children’s psychiatric hospital: the
Oklahoma Forensic Center, Griffin Memorial Hospital, and Oklahoma Youth Center. Residential care for
adults with mental illness is provided by 32 providers. The Department operates substance abuse treatment
programs within eight state operated facilitates, including some CMHCS, and contracts for services with
approximately 80 additional substance abuse treatment providers and as many as 30 separate prevention
programs. As evidence of transformation, the ODMHSAS delivery continues to operate in an increasingly
more integrated manner with collaboration and merging of functions across the realms of mental health,
substance abuse, and prevention services.
SE Q UOY AH
WAG ONE R
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WOODW AR D
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S E RV ICE A RE A 21
SE RV ICE A R E A 10 S E RV ICE A RE A 12 S E RV ICE A RE A 11 SE RV ICE A RE A 1
C HOC TAW
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S E RV ICE A RE A 8
S E R V ICE A R EA 1 7
S E RV ICE A RE A 15
SE RV ICE A RE A 7
S E R V ICE A R E A 6
S E R VICE ARE A 1 6
S E RV ICE A REA 1 3
S ERV ICE S A R E A S
S ER VICE ARE A S 2, 3 , 4 , & 5
14, 18 , 19 & 20
Communi ty M ental H ealth C ente r Service Are as
Figure 1.
Infrastructure to Support the Delivery System. The Mental Health and Recovery (MHR) Division, under
the direction of the Deputy Commissioner for Mental Health, provides planning, monitoring, technical
assistance, and other support to consumers, families, and providers involved in the state-funded mental
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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health delivery system. The Director of Community Based Services (CBS) and the Director of the Office of
Children, Youth, and Families report to the Deputy Commissioner and coordinate approximately 40 central
office-based employees who provide statewide support and management of the delivery system. Within the
CBS and Children’s teams are specialists in areas such as older adults, housing, employment, transition
services, case management, PACT, Wraparound Program, Peer Recovery Support, and Family Support
Services.
It is noteworthy that, during the past year, children’s services within the ODMHSAS were reorganized into the
Office of Children, Youth, and Families as referenced above. The Director of this office co-reports to the
Deputy Commissioners for both Mental Health and Substance Abuse Services. The office represents the
ODMHSAS in many partnership activities with other child-serving agencies.
Consumer/Family Support & Advocacy. The ODMHSAS Office of Consumer Affairs plays a vital role
within the delivery system by assisting with access on behalf of those requesting services as well as bringing
viable consumer voices to planning and policy discussions within the state mental health and substance
abuse authority. The ODMHSAS also continues to support the activities of the Oklahoma Mental Health
Consumer Council (OMHCC), the National Alliance on Mental Illness – Oklahoma (NAMI-OK), the
Depression and Bipolar Support Alliance (DBSA), the Oklahoma Federation of Families, and Oklahoma
Citizen Advocates for Recovery and Treatment Association (OCARTA). Consumer, family, and youth
organizations are key partners in planning, monitoring, and evaluating community-based services in
Oklahoma. The ODMHSAS Advocacy Division, established in 1990, is charged with the responsibility to
safeguard the rights of people receiving services throughout the ODMHSAS system. The Advocate
General reports directly to the ODMHSAS Governing Board and the Commissioner.
FFY2010 Application Updates: The Office of Consumer Affairs has been reorganized as the Office of
Recovery and Wellness. A director for this office joined the ODMHSAS staff in 2009 and is responsible for
expanding state level infrastructure for peer recovery support services, linkages with advocacy organizations,
and developing strategies to address overall health and wellness issues of consumers who receive services
throughout the ODMHSAS system. Integration of primary and behavioral health will be a specific focus of
this office.
FFY2011 Application Updates: In FY2010 the Office of Wellness and Advocacy developed seven
regional consumer groups throughout Oklahoma. Each group meets monthly and representatives then also
met with other groups to discuss needs, educate communities and provide feedback to the ODMHSAS.
Quarterly meetings with representatives from all regional groups were then conducted via video conference.
The ODMHSAS Office of Wellness and Advocacy also coordinated with the Oklahoma Mental Health
Consumer Council (OMHCC) to provide Key Leadership Training. OMHCC activities for this project were
funded through a SAMHSA grant to consumer organizations. In collaboration with the Department of Health,
a pilot project was initiated to provide primary health and dental care to people with a Serious Mental
Illness without health coverage. This project involves a Federally Qualified Health Center and a Community
Mental Health Center. Two other sites have been selected to further pilot this initiative.
Management Information Systems. The Information and Decision Support Services Division (IDSS) is
responsible for the management information system of the ODMHSAS. This group was recently realigned
under the lead of the Chief Information Officer (CIO). IDSS includes approximately 40 staff to organize a
robust information system that is closely integrated with service delivery, performance improvement, systems
transformation, legislative and public policy analysis and planning at local, state, and national levels.
Strategic planning specific to several of these functions is being organized through the Information
Technology Steering Committee appointed by the Commissioner and chaired by the CIO.
A key source of information is the Integrated Client Information System (ICIS) which captures demographic
and encounter data at the unique client level. All services funded in part or entirely by the ODMHSAS are
entered into this data system. ICIS data are used to generate payment information to providers through fee-for-
service (automated service invoicing) systems.
IDSS analysts extract data from ICIS and other sources, compile responses to service recipient surveys,
respond to internal and external requests for information, and support block grant and accreditation
compliance. They maintain state and national web sites and create reports and fields to support grants,
performance and outcomes assessments, and other projects. IDSS develop, implement, and assist
Department evaluations of pilot programs, federal grant initiatives, performance indicators, and other data
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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based analysis. IDSS is responsible for the Data Infrastructure Grant (DIG) and the Uniform Reporting
System (URS). These functions are closely coordinated with all Mental Health Block Grant activities. IDSS
staff is always present at Mental Health Planning and Advisory Council meetings to assist with inquiries
about data, trends, and performance improvement.
Human Resources Development and Performance Improvement. These are also key elements of the
ODMHSAS and provide essential functions to transformation and a recovery-informed system. These are
discussed in more detail as resource management features under Criterion 5 of this Plan.
Support, Advocacy, and Collaboration. Oklahoma continues to enjoy the benefits of collaboration and
active partnerships among multiple constituencies and peer state agencies. The partnerships have created
exciting opportunities for support, advocacy, and systemic improvement on behalf of Oklahomans across the
life span. Some of these are described in detail in the Adult Plan. Items specific to the needs of children and
their families are addressed in more detail throughout the remaining sections of the Children’s Plan.
The ODMHSAS’s Role and Relationship within State Government. The ODMHSAS is a distinct agency
within state government. As the single agency for mental health and substance abuse services, the
ODMHSAS participates in numerous strategic relationships with other state agencies. The ODMHSAS is
assigned within the Executive Branch of state government under the Governor’s Cabinet Secretary for
Health. The ODMHSAS, as directed by Governor Brad Henry, is also the lead agency for the
Transformation State Incentive Grant, through which Oklahoma addresses substance abuse and mental
health as aspects of overall health for the state.
Legislative Initiatives and Changes. Most Oklahoma state agencies were faced with the impact of a
reduced or no-growth revenue scenario for 2008. This continues to impact planning and presents
immediate and long-term challenges to the state. With only limited increases, the following highlights
selected legislative actions completed during the 2008 Session.
• Basically, the ODMHSAS received funding at the near identical level to that appropriated in 2007.
Although this will allow the state to continue all existing and previously funded mental health and
substance abuse services, the actual impact of level funding is yet to be seen. Service providers will
be challenged to maintain the same level of services as in previous years while balancing increased
costs in delivering those services.
• An additional $2 million was appropriated specifically for a coordinated plan in Tulsa to address
homelessness and housing needs for people with mental illness.
• Revisions were made to state law to permit broader use of telemedicine for the delivery of
psychiatric services. Amendments allow for use of this technology for initial assessments and to
redefine telemedicine as the equivalent of physical contact for purposes of psychiatric medical
services.
• The scope of the state’s suicide prevention council was amended to include suicide throughout the
lifespan as opposed to focusing only on youth.
• Several initiatives were passed that improve the operations of the ODMHSAS, including revisions to
the Commissioner’s duties (removing antiquated language), establishing an external review board to
conduct annual reviews for individuals found not guilty by reason of insanity, and adding physicians
assistants to the list of licensed mental health professionals.
• A bill passed directing the ODMHSAS to establish a Mental Health First Aid offering once available
resources are identified to support the program.
In addition, specific interim studies will be conducted to gather information and consider legislation for the
2009 session. This includes a specific study on the impacts of incarceration on women. Oklahoma has the
highest rate of female incarceration in the United States. The Mental Health Planning and Advisory Council
proposed to facilitate regional discussions to solicit input on the potential need to revise sections of Title 43A,
the state mental health statute, in order to provide clarification regarding options and protections that need to
be in place when adults are being considered for emergency orders of detention and for involuntary Civil
Commitment for treatment.
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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FFY2010 Application Updates: Legislative Initiatives and Changes (2009). Oklahoma experienced
significant revenue declines in FY09, prompting the legislature to cut agency appropriations for FY2010. For
ODMHSAS, the agency received a 2% cut compared to the FY09 appropriations base. As most legislative
attention was budget related, little activity occurred related to services for people living with mental illness.
The budget environment continues to impact planning and presents immediate and long-term challenges to
the state mental health treatment system. The following list highlights related legislative changes passed in
the 2009 legislative session.
ODMHSAS was appropriated 2% less for services for FY10 than was appropriated for FY09. Adding to this
revenue challenge are unfunded mandates related to employee benefits increases amounting to an
additional 1% purchasing erosion for treatment services. The ODMHSAS approved an FY10 budget that
maintained comparable access to services for Oklahoma consumers but at the expense of access
expansions and consumer convenience. With a state revenue failure likely for FY10, the state has no margin
of error should there be additional revenue loss meaning access to services could be cut if there is no
improvement in the fiscal environment.
Statutes were revised to allow emergency detentions to occur in appropriate facilities in other state
jurisdictions if geographical criteria are met and the receiving facility voluntarily accepts the consumer.
A law was passed to allow individuals previously convicted of a felony and were under licensure (including
mental health professionals) to have better due process in the reinstatement process. This is important as
many Oklahomans who run into legal trouble due to untreated mental illness and have returned to recovery
while incarcerated or post-incarceration will have better opportunity to re-enter their chosen profession.
A bill passed clarifying medical stabilization and transportation for those in need of treatment for psychiatric
distress and experiencing a co-occurring health condition requiring general medical care.
The title of state law related to the Children's Code was rewritten, resulting in several positive changes for
children in need of mental health services and in state custody. The rewrite did contain one item related to
dispensing psychotropic meds to children without judicial consent which will require amendment next
legislative session due to the prohibitive nature of the section in legislation related to this topic. In the
interim, the parties involved have identified a temporary solution to meet the needs of affected children until
the next legislative session convenes.
FFY2011 Application Updates: Legislative Initiatives and Changes (FY2010). Most Oklahoma state
agencies were faced with significant cuts for FY11. These cuts came on the heels of a very painful FY10
that saw ODMHSAS’s infrastructure decimated by $20 million in cuts (7.5%). These cuts continue to impact
planning and present immediate and long-term challenges to the state. The budget and a few selected
legislative measures dominated legislative session in 2010.
Considering the 0.5% cut to ODMHSAS mandated by the 2010 legislative session, ODMHSAS state
appropriated funding reversed to FY06 levels. In this retreat, mental health providers experienced a
reduction in contract and service amounts. Important supportive services have been shuttered or
restructured.
The ODMHSAS was authorized to issue bonds to build a new inpatient facility in Tulsa through a 50/50
private public partnership. Construction on the 26 bed facility (estimated to cost $12 million) can begin when
$6 million in private donations are secured.
Revisions were made to state law to extend the period of emergency detention from 72 to 120 hours. This
will provide many consumers extended time to achieve competency in a structured crisis center and likely
avoid a lengthy civil commitment to a state hospital.
Statutes related to the ODMHSAS Advocate General’s office were revised to clarify roles. The Advocate
General’s office will now focus on access to services and consumer rights while the ODMHSAS Investigator
General will handle any investigations that are warranted.
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
11
Several initiatives were passed to improve the ODMHSAS operations, including revisions to the
Commissioner’s duties (removing antiquated language) and establishing a statutorily required certification
process for Recovery Support Specialists.
Legislation passed to provide ODMHSAS greater flexibility in meeting difficult budgetary periods by removing
mandates to operate specific facilities.
A diversionary program, in partnership with the Oklahoma Department of Corrections, was passed with a
specific emphasis on meeting the needs of incarcerated women.
Other New Developments – Services Across the Lifespan
Transformation State Incentive Grant. Oklahoma is one of nine states funded through the SAMHSA
Transformation State Incentive Grant (TSIG) program. The availability of these resources and the TSIG-structure
itself continued to spawn new developments in the past year. These are highlighted
throughout this plan. Transformation activities are guided under the direction of the Governor’s
Transformation Advisory Board (GTAB) comprised of 18 members at large and the directors of ten state
agencies. The at-large members include consumers, family members, youth, legislators, advocates,
higher education, law enforcement, business, and philanthropy.
TSIG activities are organized within the framework of the Oklahoma Comprehensive Plan for Substance
Abuse and Mental Health Services. The plan was submitted to SAMHSA in October 2006 and was
based on findings documented in an extensive Needs Assessment and Resources Inventory Report,
also completed in 2006. The plan is dynamic and ever-changing but highlights in excess of forty
strategies to guide the state to achieve its vision for transformation – All Oklahomans will prosper and
achieve their personal goals in the communities of their choice.
Transformation activities are supported by the Innovation Center and are organized to provide
coordination, technical assistance, and change tools to help multiple state and local partners achieve the
vision for transformation (see www.OkInnovationCenter.org). The state’s intent is for MHBG and
transformation activities to continue to have close alignment and synergy.
FFY2011 Application Updates: Transformation State Incentive Grant (TSIG). In 2010 TSIG funds
supported continuation of recovery support training for consumers. Trainings were held within communities
statewide and in four prisons to help individuals gain skills to advocate for themselves and others while
incarcerated.
Cultural competency training for agency staff and Culture Vision were implemented in 2010. Culture Vision
is a web based tool for clinicians, accessible in real time to provide accurate information and evidence based
guidance related to ethnicity, religion, and culture. It is accessible on desktop computers to all ODMHSAS
funded providers throughout Oklahoma.
The TSIG tribal state relations workgroup developed an educational series on Cross Cultural Awareness.
This in 2010 and continue during FY11 to educate providers on the effects of historical trauma and on tribal
cultures and customs of their specific region of the state. This collaborative is a partnership between the
ODMHSAS agency staff and five of the tribal governments headquartered in Oklahoma.
Behavioral health screening within primary care as a TSIG funded initiative and partnership between the
Oklahoma State Department of Health and the University of Oklahoma, and the ODMHSAS was initiated.
Screening for developmental, social emotional and behavioral health issues occurred is now available in
primary care and hospital settings. Technical assistance and consultation by state agency staff supported
practitioners to become involved in the initiative.
Pending continued availability of TSIG funds, the Innovation Center will work with a professional agency to
develop and implement a statewide public awareness campaign to increase understanding of mental health
and substance abuse resources and the concept of recovery.
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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Telemedicine. TSIG funds have supported the development of video conferencing technology. Initial
units were purchased in 2008 and deployed throughout the state as the first phase of Oklahoma’s
Telehealth Network. These initial units were placed in community mental health centers and their
satellite locations serving rural settings. The initiative is describe in more detail under Criterion 4. The
ODMHSAS expects additional people will be served as well as increased service delivery efficiencies will
results.
FFY2011 Application Updates: Telemedicine. The Oklahoma Telehealth Network (OTN) increased to
over 130 endpoints at 78 locations throughout the state in FY2010. This network has eliminated many
geographic, financial, and workforce barriers that existed within Oklahoma’s previous service delivery model.
The infrastructure created by the OTN has enabled other state agencies to increase access to care. For
example, the Oklahoma Department of Human Services now uses the OTN infrastructure to link children in
higher levels of care to their home town social workers and families. The OTN works with the Veterans
Administration to provide veteran-specific training and education to veterans and their families statewide.
The ODMHSAS and Indian Health Services collaborate and use the OTN to provide remote wound
management and behavioral health consultations, which is a priority in Indian Country. To better coordinate
primary and behavioral health care, fifteen primary care doctors, each with their own subspecialty, have
agreed to provide consultative services, via telehealth, to the CMHCs. CMHCs can now access consultants,
other providers, and conduct meetings and trainings via this technology. This significantly decreased the
cost of doing business significantly. The ODMHSAS estimates the OTN saved the state over $350,000
every quarter of FY2010. A consumer and provider survey was developed to solicit input on satisfaction
within the system. Surveys received thus far have been informally analyzed and reflect positive consumer
and provider satisfaction with the delivery of telemedicine services.
Integrated Payment and Information Systems. The ODMHSAS and the Oklahoma Health Care
Authority (OHCA), the Medicaid Authority, continue to redesign a seamless system of care for adults so
that services are recovery-informed, consumer-driven, and organized as a virtual single delivery
system. Much of this work has occurred within the Adult Recovery Collaborate (ARC) and has set the
stage to integrate the ODMHSAS and OHCA payment and data systems to benefit both children and
adults receiving publicly funded behavioral health services. The ARC Interagency Steering Committee,
which also includes the Department of Human Services, continues to work toward systems
transformations by which all public supported behavioral health services (Medicaid and ODMHSAS
funded) can be jointly managed between the two agencies under the leadership of the ODMHSAS.
Major objectives are an integrated information and payment systems to improve access and
accountability, alignment (when appropriate) of benefits between Medicaid and the ODMHSAS, and
increased consumer and family choices in services. Policy changes, Medicaid State Plan amendments,
and joint staffing of numerous initiatives are outgrowths of the Adult Recovery Collaborative. For the
coming year, it is anticipated that claims for both the ODMHSAS and the OHCA billable activities will be
processed through a single system. That is a fundamental objective of this initiative. Data sharing
agreements and other blended funding activities are underway to improve access, choices, and
effectiveness on behalf of both children and adults receiving publicly funded behavioral health services in
Oklahoma.
FFY2011 Application Updates: This initiative is now referred to as the Consolidated Claims Processing
(CCP) system and went live July 1, 2010. During FY2010 extensive testing and finalization of procedures
occurred. The ODMHSAS expects, as a result of the new system, to utilize much broader bases of data to
better monitor and plan public mental health and substance abuse services. The system can more efficiently
identify additional sources of payment for services and thereby further leverage state and federal funds for
services. Finally, the new system will be provider friendly in that enrollment, utilization, and payment are all
managed through a single point information system. It is anticipated that data reported for the FY2011
MHBG purposes will be enhanced as a result. The CCP system includes services to both adults and
children.
Medicaid Changes. In addition to the integrated systems work described above, the Oklahoma Health
Care Authority (OHCA) and partner state agencies worked closely in 2008 to expand reimbursable
services through the Medicaid program. Recent developments include seeking final approval from the
Centers for Medicare and Medicaid Services (CMS) to add Family Support and Training and Community
Recovery Support to the Medicaid reimbursement program. Medicaid (OHCA) and the ODMHSAS
continue to collaborate with providers to revise outpatient behavioral health procedures to increase
consistency between the two state agencies, synchronize documentation requirements, and economize
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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on certification and accreditation costs. The legislature did not approve a budget request submitted for
residential treatment for substance abuse/integrated services in the Medicaid program. Efforts to include
this in the Medicaid program will continue in the upcoming legislative session. The Center for Medicaid
and Medicare Services (CMS) recently approved a revision to the State Plan to reimburse the
ODMSHAS-credentialed Recovery Support Specialists. Similar approval for Family Support Providers
is pending. CMS has required Oklahoma to “unbundle” Program of Assertive Community Treatment
(PACT) rates to a more traditional fee-for-separate-services approach. This necessitated close
collaboration between the OHCA and the ODMHSAS to minimize fiscal impact and assure continued
compliance with PACT model fidelity.
FFY2011 Application Updates. Medicaid. Primary work related to Medicaid for FY2010 and carrying
forward to FY2011 will be connected to the Consolidated Claims Payment System that is described
elsewhere in this application update.
Housing Policy Developments. Statewide and community stakeholder groups continue to meet to
address housing and related issues.
The Oklahoma Governor's Interagency Council on Homelessness (GICH) continues to work on
implementation of the state action plan on homelessness. One goal of this plan is to increase access
to safe, affordable, and permanent housing for homeless individuals and families and individuals and
families who are at risk of becoming homeless. The current focus of the GICH breakout committee
working on increasing access to safe and affordable housing is to develop a Statewide Housing Trust
Fund with a constant source of revenue, and assistance with developing or enhancing community/local
level planning for housing development. Over the course of the last year, this breakout committee has
been working on a Housing Trust Fund Campaign and has garnered new support for this initiative
through partnerships with local foundations.
Through Olmstead funding and Transformation State Incentive grant funds, the ODMHSAS continues to
fund a Housing Support Specialist position that was added last year. The focus of this position is to
assist with development, promotion, and support of housing initiatives. This Specialist has been
instrumental in the movement of the Housing Trust Fund initiative and is currently developing a training
curriculum on housing support services. Training will be targeted to direct service providers such as
case managers, and will focus on giving them the knowledge and skills needed to help
people successfully access and maintain safe and affordable housing.
The GICH and the ODMHSAS continue to sponsor, along with other stakeholders, a Statewide
Homeless Conference every two years. The next conference is scheduled for fall 2008 and the focus
will be "Creating Lasting Solutions." Transformation State Incentive Grant funds are utilized to assist the
GICH with development and ongoing maintenance for a GICH website. The website will serve as a
statewide website for homelessness and for people at risk of becoming homeless. An initial BETA
version has been developed and is currently in the process of being revised and finalized. It is projected
that the website will go live by January 1, 2009.
Transformation State Incentive Grant funds are approved to fund three Regional Housing Facilitators for
the ODMHSAS. Under the direction of the Director of Treatment and Recovery, the Facilitators will work
to develop, expand, and maintain the number of safe, affordable, and quality permanent housing options
for people with mental illness or co-occurring mental illness and substance abuse disorders within their
assigned regions. The ODMHSAS plans to have these positions filled by December 2008.
FFY2010 Application Updates: Updates related to the above topics as well as other developments
expected to impact service systems in FY2010 are included in both the Adult and Child plans under the
topics of “System Strengths, Needs, and Priorities.”
FFY2011 Application Updates: Housing Policy Developments. The GICH helped develop the Housing
Trust Fund Alliance, a group of volunteer stakeholders. This group and others continued the efforts to create
a Statewide Housing Trust Fund. This was the third year the groups advocated for needed legislative
language and funding to facilitate this. The proposed bill remains dormant due to lack of action. The current
focus is to identify Legislative Champions for the coming year, and garner grassroots level support to
campaign for passage of the bill. One ODMHSAS Housing Support Specialist is the as lead support staff for
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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the Housing Trust Fund Alliance. In FFY2010 she began training providers and other community
stakeholders to more effectively assist consumers with accessing and maintaining housing. At least ten
trainings were provided in FY2010.
The GICH website went live earlier in 2010. It is maintained by GICH members and the Oklahoma City
based City Rescue Mission.
ODMHSAS Regional Housing Facilitators were active FY2010 and had successes with the creation of new
units and in facilitating community partnership. These activities improved access to housing and services for
people with mental illness and their families.
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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System Strengths, Needs, and Priorities
Adults
Adult Service System’s Strengths and Challenges. The following items are summarized from the Needs
Assessment and Resources Inventory Report completed in connection with the transformation activities.
Emphasis on these areas will continue through the FFY 2009-2011 Mental Health Block Grant Application
cycle. This also coincides with the timeframe for the Transformation State Incentive Grant.
Strengths (Adult System)
• Evidence of a strengths-based and recovery-oriented framework.
• The ODMHSAS state-level staff empowers providers, consumers, families, and youth by providing
technical assistance to all components of the system.
• The ODMHSAS leadership’s value on the purveyance of emerging and evidence-based practices.
• Infrastructure for the state’s Psychosocial Rehabilitation Model which emphasizes choice and
recovery in lieu of older and traditional day service programs.
• Information and data-informed performance reporting on system changes to support improvement.
• The expansion and sustainability of the ODMHSAS Office of Consumer Affairs.
• Ongoing work by statewide and local consumer and family organizations, including the Oklahoma
Mental Health Consumer Council, the National Alliance on Mental Illness-Oklahoma, and the
Depression Bipolar Support Alliance.
• Success of the Integrated Services Initiative that was initially funded by the SAMHSA Co-Occurring
State Infrastructure Grant (COSIG).
• Consumer/recipient feedback processes through perception of care surveys and strategic
stakeholder meetings.
• The Oklahoma Health Care Behavioral Health Advisory Council that brings to the table an extensive
constituency base for policy advice and systemic improvement.
• An active Coalition of Advocates works to prioritize, coordinate, and unify information and proposes
improvements through the legislative process.
Challenges (Adult System)
• The transitional nature of the current adult service system.
• The expanding unmet needs of serving older adults which is impacted by a limited interface between
the traditional ODMHSAS service system and the other aging services delivery systems.
• The system’s lack of capacity, infrastructure, and expertise to implement the full range of evidence-based
practices for adults.
• Individual consumers continue to have limited choices in the range of services, providers, and
access to non-traditional services.
• Workforce limitations in terms of the current workforce, recruiting, and retaining new workers to the
adult services system.
• Limited cultural diversity within the provider pool.
• Policies promulgated at the federal level through the Center for Medicare and Medicaid Services
(CMS) that reinforce older philosophies of a medical model versus recovery approaches are
impacting the state. Specifically, the CMS decision to require Oklahoma to “unbundle” its funding
structure for the Program of Assertive Community Treatment (PACT) is difficult to implement and
maintain program fidelity.
Additional challenges identified by advocates include difficulty with accessing services in all areas of the
state and many remaining unmet needs related to housing, transportation, and employment.
Unmet Service Needs. (Adult System) The previous section on Service Systems Strengths and Challenges
highlights these. The source of the data is the Needs Assessment and Resources Inventory Report
completed in 2006 as part of the state’s transformation initiative.
Plans to address Unmet Needs. (Adult System) As referenced earlier, the Oklahoma Comprehensive Plan
for Substance Abuse and Mental Health Services developed in 2006 as transformation activities established
a framework to address unmet needs. The plan was recently updated to reflect selected priorities. Initiatives
that will address the needs of adults are listed below.
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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• Develop an anti-stigma campaign targeted for staff of state agencies.
• Train staff in Cultural Competency.
• Develop telehealth network to improve access to care for rural Oklahomans.
• Fund Consumer, Family and Youth Leadership Academies.
• Develop peer-run wellness centers.
• Fund designated FTEs to develop improved access to housing for persons with behavioral
health issues.
• Develop partnerships with Latino agencies to improve access to care for Spanish speaking
individuals with behavioral health needs.
• Provide incentives for behavioral health screenings in primary care settings.
• Develop funding for university students and researchers to conduct evaluations relevant to the
behavioral health field.
Recent Significant Achievements. (Adult System) The state’s adult-serving system continues to be
dynamic and focused on infrastructure improvements and cross-agency collaborations. Examples of
improvements noted during the past year are described below.
Veteran’s Policy Academy. Oklahoma was awarded funding to participate in a SAMHSA-sponsored
Veteran’s Policy Academy. The Academy team consists of twelve representatives of various
constituencies related to mental health, substance abuse, and veterans’ issues.
Strengths Based Case Management. The ODMHSAS and the Oklahoma Health Care Authority
(Medicaid) were able to develop a strategy to expand workforce in the area of case management
services with the development of a career ladder approach that will provide entry into this field by
providers with a wider range of educational and experiential backgrounds.
Executive Leadership Academy. Over 30 employees graduated from the first ODMSHAS Executive
Leadership Academy class in 2008. Many of those employees have already transitioned into new
management and leadership positions within the agency. Each participant was required to present a
capstone project. Project topics included, for example, veterans’ issues, “dashboard” data systems, and
linguistic and cultural competencies. The ODMHSAS Leadership Academy received the Governor’s
Award; the top honor granted as part of the Oklahoma Quality Initiative.
Program of Assertive Community Treatment (PACT). Oklahoma’s PACT program continued to
provide effective services throughout 2008. As of June 30, approximately 800 consumers were
receiving PACT services through one of the state’s 14 PACT teams in operation in 2008. One team will
transition from the full fidelity model to an intensive case management model in the coming months in
order to better balance resources and needs within the rural southern Oklahoma area. PACT is also
discussed in the plan relative to challenges facing the state as a result of CMS requiring Oklahoma to
“unbundle” Medicaid reimbursement rates.
Justice and Related Initiatives. Oklahoma has implemented multiple strategies to more effectively
address the needs of persons with mental illness and addiction disorders who are also impacted by
juvenile and adult corrections systems. Major emphasis is placed on coordination with corrections, law
enforcement, and courts. Programs are in place to provide early identification, diversion, incarceration-based
treatment, and successful community reentry. Descriptions of these programs follow.
• A highly successful jail diversion program (Tulsa) and day reporting program (Oklahoma City)
continue to operate and provide flexible community-based services to wrap services around
persons at risk of entering or returning to these metropolitan jails.
• Over 260 law enforcement personnel in approximately 23 counties have been trained in the
Memphis Model/Crisis Intervention Training or a similar law enforcement-based diversion program.
• Twelve mental health courts are in place. Two are in the major metropolitan areas and all others
are in rural communities.
• Drug courts for both adults and/or juvenile offenders are in place in 59 of 77 counties. Funding for
drug courts include resources for substance abuse as well as for co-occurring mental health
treatment.
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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• Funding continued in 2008 to support four Reentry Intensive Care Coordination Teams (RICCT).
The teams are comprised of a specifically trained Intensive Case Manager and a Recovery (Peer)
Support Specialist to provide success oriented and strengths based reentry support following
incarceration.
• The ODMHSAS has provided three Discharge Planners to work within targeted prisons within the
Oklahoma system. Discharge Planners are located with prison treatment staff to identify inmates
preparing for reentry who will have ongoing mental health and substance abuse treatment needs.
Discharge Planners and the RICCT’s work closely together, along with corrections staff, and under
the direction of the ODMHSAS Director of Community Based Services.
• Three co-occurring treatment specialists, employed by the ODMHSAS, work in two state prisons
and three community correction facilities to provide co-occurring treatment to inmates identified as
in greatest need of integrated treatment for mental illness and addictions issues.
• Oklahoma is also the target site for a Medicaid reinstatement pilot project for reentering offenders.
This is funded by CMHS and coordinated through Mathmatica Policy Research, Inc. This project
has engaged staff from multiple state and federal entities to analyze and design effective
approaches to assuring immediate access to Medicaid and Social Security benefits upon
community reentry from prisons and state hospitals.
• Family members, advocates and consumers of mental health and substance abuse services are
reporting one impact of many of these initiatives is a shift within the Department of Corrections
facilities to focus more on rehabilitation, recovery, and person-center plans that will support a more
normalized return to their home communities.
Peer and Family Advocacy
• WRAP and Consumer Training. The ODMHSAS contracts with the Oklahoma Mental Health
Consumer Council (OMHCC) to continue the Wellness Recovery and Action Plan (WRAP) training.
In state FY08, over 400 consumers completed a WRAP course. OMHCC conducts an annual
consumer conference that provides intensive training for consumers and expanded opportunities
for networking with peers across the state. OMHCC has been effectively providing WRAP
in diverse settings, including jails and state prisons.
• Family-to-Family and Other NAMI-based Support Programs. The ODMHSAS contracts with
NAMI-OK to provide a variety of educational services, including Family-to-Family, Visions for
Tomorrow (VFT), Hope for Tomorrow, and Peer to Peer. In 2008 over 500 people participated in
these programs.
• Consumer Involvement Standards. Oklahoma’s TSIG evaluation will include measures, under
development, to determine the extent to which consumers are impacting individual and local
organizations as well as state-level decisions regarding mental health and substance abuse
services. A workgroup of consumers drafted and field-tested standards in 2008 to be used in this
evaluation project. Results of field-testing will be used to finalize and implement the standards as
a tool to measure and increase consumer involvement at all levels of the service system. This
model is being supported and closely followed by SAMHSA as a potential template for other
states.
• Recovery Support Specialists. The ODMHSAS continues to train and credential Recovery
(Peer) Support Specialists. At the time of this application, approximately 175 have been trained
through the ODMHSAS Office of Consumer Affairs, more than doubling the number from 2007. A
broader group of stakeholders has been engaged and revised the training and credentialing
process to expand the numbers, settings, and diversity of persons in recovery who are qualified to
provide peer recovery services. Collaboration has included constituencies from mental health,
addictions, corrections, faith-based organizations and the state Medicaid authority. Medicaid
reimbursement has been approved for this service.
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Implementation of Evidence-Based Services
• Illness Management and Recovery. During state FY08, four CMHC-based Psychosocial
Rehabilitation Programs implemented Illness Management and Recovery (IMR) as the SAMHSA
evidence-based practice. This initiative will interface with a transformation-based evaluation
project to determine the impact of IMR on consumers’ perceptions of care and outcomes.
• Supported Employment. The ODMHSAS and the Department of Rehabilitation Services (DRS)
have continued with improvements to expand supported employment as an evidence-based
practice. The DRS Milestone (provider reimbursement) mechanism for related services was jointly
evaluated by the ODMHSAS and DRS to determine its effectiveness in serving people with mental
illness. As a result, a new Milestone configuration was proposed and approved by DRS's Board to
be utilized for specialized mental health supported employment best practices contracts.
FFY2010 Application Updates:
Transformation State Incentive Grant. Substantial progress in transformation activities was made in
FFY09 to help the Oklahoma workforce gain skills needed to provide effective treatment and develop
supports within the system. Training for licensed and unlicensed staff in evidence base practice,
collaboration with universities to prepare students for work within the Department of Corrections system,
training probation and parole officers and institutional staff in recovery principles, continued expansion of
peer recovery support training, development of consumer, family and youth leadership academies, and
cultural competency training of trainers through the National Multicultural Institute to prepare staff to work
with culturally diverse consumers in Oklahoma.
In addition to staff training, some of the other initiatives underway in FFY09 include, partnering with the
Oklahoma State Department of Health, Child Guidance Division to offer training and consultation to
physicians primarily treating young children to screen for social emotional and developmental delays. TSIG
offered incentives by providing the physicians with selected tools for screening and child guidance staff at the
local level trained and offered consultation to physicians. Screening efforts within hospital emergency rooms
is also underway through a private-public partnership with several hospital systems in Oklahoma to screen
for alcohol and drug abuse. Transformation activities are supported by the Innovation Center and are
organized to provide coordination, technical assistance, and change tools to help multiple state and local
partners achieve the vision of transformation. The current implementation plan for the state may be viewed
at www.okinnovationcenter.org.
Telemedicine. Statewide infrastructure has improved to support video conferencing, telehealth, and
telecourts. ODMSAS hired a Coordinator for Telehealth. That individual provides support and strategic
development to approximately 80 teleconferencing sites funded through the ODMHSAS. The sites provide
telehealth, telecourt, and administrative meeting support through this statewide network.
Integrated Payment and Information Systems. December 1, 2009 is the targeted launch date for the
integrated payment system .
Medicaid. The Center for Medicaid and Medicare Services (CMS) recently approved a revision to the State
Plan to reimburse the ODMHSAS-credentialed Peer Recovery Support Specialists and Family Support
Providers.
Housing Policy Developments. Oklahoma will submit an application to extent Olmstead funding two
additional years. If approved, funds will be used to continue initiatives begun under the original Olmstead
grant. The grant partially funds the salaries of the Director of Treatment and Recovery and one state-level
Housing Support Specialist – both who work within the Community Based Services Division of the
ODMHSAS.
Although the Legislature has not yet approved appropriations for a Statewide Housing Trust Fund, the
Governor’s Interagency Council on Homelessness (GICH) and others are developing strategies to establish
statewide grass roots support for new state resources to support housing development.
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The Governors Transformation Advisory Board (GTAB) approved use of Transformation State Incentive
Grant (TSIG) funds for three Regional Housing Facilitators. Two of those positions are now filled – one for
the north eastern section of the state and one for the Tulsa metropolitan area. Recruitment continues for the
third Facilitator who will be based in the Oklahoma City metro area.
The Mental Health Association in Tulsa (MHAT) continued with development of a new project that will make
housing available for former residents of the Safe Haven currently located in downtown Tulsa YMCA. That
building will be eliminated as a result of developments and building in Tulsa. The new Tulsa project
employs an integrated housing approach where by the former Safe Haven residents will reside within a
larger apartment complex. Development of that complex received significant public attention during 2008
and 2009 – much of which required proactive anti-discrimination strategies on the part of the MHAT and
other leaders in the Tulsa area.
The City Rescue Mission in Oklahoma City continues to work closely with the GICH to launch a website to
support activities of the GICH. The launch is expected by January, 2010.
A Residential Care transition project was initiated for SFY 2010. This project provides the opportunity for
operators of ODMSHAS contracted residential care homes to apply for funding incentives to support
residents to transition from the ResCare settings to permanent supporting housing in the community. TSIG
and state appropriations will be used to support this. Eligible ResCares will receive additional funding as
specific milestones are achieved on behalf of specific residents who will or have transitioned to permanent
supported housing. Milestones are based on completion of intensive training of ResCare staff and residents,
on-site reviews, and housing retention – including a final payment after one year of successful housing
retention for each consumer served.
Justice and Related Initiatives. Crisis Intervention Training (CIT) continues to involve collaboration
between numerous law enforcement entities and the ODMHSAS. To date, over 500 law enforcement
personnel have been trained statewide. The ODMHSAS contracts with the Oklahoma Association of Chiefs
of Police for limited support of the CIT project, including publicizing trainings and tracking numbers of
trainees who complete the program.
In 2009, the ODMHSAS and Department of Corrections modified CIT and developed Corrections Crisis
Resolution Training (CCRT) for probation, parole, and correctional officers. Piloted trainings have been
completed and schedules are now in place to train at least 250 participants in 2010. This project is partially
supported with TSIG funds.
Mental health courts continue to expand and demonstrate efficacy. Federal stimulus funding sub granted
through the Attorney General’s Council Justice Assistance Grant Board, will allow the ODMHSAS to add
additional courts in 2010. By January 2010, fifteen courts are expected to be in operation. Mental health
court operations and expansion are closely coordinated with the statewide initiate for drug courts. Some
courts particularly focus on participants with co-occurring mental health and addiction disorders. Over 50
drug courts are also in operation throughout the state. Outcome data systems closely track the performance
of each court and the impact on persons served.
Peer and Family Advocacy. The ODMHSAS Office of Consumer Affairs was reorganized under new
leadership in FY2009 and staffed by the Director of Advocacy and Wellness. The Director of that office
coordinate much of the peer and family advocacy work that occurs in cooperation with the ODMHSAS.
ODMHSAS has contracted with NAMI to work with the Department of Corrections to develop WRAP training
and Peer Recovery Support Specialists in the prisons and Community Corrections facilities.
The Consumer and Advocacy groups have united to present a joint conference in the spring. The groups
include Oklahoma Mental Health Consumer Council (OMHCC), the National Alliance on Mental Illness
(NAMI-OK), the Depression and Bipolar Support Alliance (DBSA), Oklahoma Citizen Advocates for Recovery
and Treatment Association (OCRTA) and the State Mental Health Coalition for Aging. The theme of the
conference will focus on wellness.
Implementation of Evidenced Based Services. TSIG funded research continues to compare the recovery
outcomes for persons who participate in the Psychosocial Rehabilitation Programs (PSRs). Within the PSR
program two groups are being followed – those that receive the SAMHSA-approved Illness Management and
Recovery (IMR) and those who do not. A consumer evaluator was hired by ODMSHAS to work fulltime on
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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this project. Over 100 interviews of PSR participants have been completed, including the four sites where
IMR is incorporated in PSR programs.
Supported employment developments have not moved at the pace originally envisioned by the ODMHSAS.
Budget reductions for the Department of Rehabilitation Services (DRS) have impacted this. However, it the
new DRS Director and the ODMHSAS Commissioner have committed to utilizing the cross-agency advisory
committee to further support supported employment strategies.
Older Adults. In FY2009, Oklahoma was awarded a SAMHSA Targeted Capacity Expansion grant for Older
Adult Mental Health. The Oklahomans Learning to Direct Recovery (OLDR) program is targeting senior
citizens in two Oklahoma counties, Comanche & Ottawa, with Wraparound case management and a
Systems of Care approach to community team building. Program consultation is ongoing from Three Rivers
Community Mental Health Center in New Hampshire and from the National Association for State Mental
Health Program Directors’ Technical Assistance Center.
Transformation State Incentive Grant funds are being used to support the Oklahoma Mental Health and
Aging Coalition. Oklahoma was the first state in the nation to develop a coalition to bring together the mental
health network, the aging network, and older adult consumers to work together for the benefit of older
Oklahomans in need of mental health and substance abuse services. The TSIG funds are used to support a
full time Mental Health and Aging Coalition developer for logistical and planning support to the Coalition and
to help grow local coalitions throughout the state. The developer will also work to closely, on behalf of
Oklahoma, with the National Mental Health and Aging Coalition.
FFY2011 Application Updates:
Transformation. Updates on the Transformation State Incentive Grant (TSIG), telemedicine, the Integrated
Payment System (now the Consolidated Claims Processing system), Medicaid, Housing Policy
Developments, and Peer and Family Advocacy have been summarized in other sections of this application.
Implementation of Evidenced Based Services. In FFY2010, the ODMHSAS continued a research
project to evaluate recovery outcomes for consumers that received Illness Management and Recovery (IMR)
within selected psychiatric rehabilitation projects. The current focus is on 12- month follow-up surveys.
Both the ODMHSAS and the Oklahoma Department of Rehabilitation Services (DRS) continue to have an
interest in further expanding Supportive Employment (SE). However, efforts were further delayed in 2010
due to the economy and State agency budget reductions.
Older Adults. ODMHSAS continues to fund one full-time position at HOPE Community Services Inc. for an
older adult program and outreach coordinator. This position works to reach older adults in the community
with mental health needs and offer them behavioral health services tailored to their specific needs. This
position also works to develop support groups addressing the special needs of grandparents raising
grandchildren and community-identified needs.
FFY2010 is the final year for the SAMHSA Targeted Expansion grant for Older Adult Mental Health. The
project is on task to solidify local systems of care for older adults in the Comanche and Ottawa counties.
There is a possibility grant funding will be allowed to extend into FY2011 for completion of the project.
Transformation State Incentive Grant (TSIG) funding for the Oklahoma Mental Health and Aging Coalition
(OMHAC) will expire during SFY2011. With the TSIG funding and dedicated staff efforts, the OMHAC
developed its first local affiliate in Tulsa. Two other communities are in final preparations to formalize their
affiliates. , OMHAC is part of Aging Services Division State Plan to develop a pilot program with 4 of the 11
aging agencies in the state to provide education and advocacy and provide the tools to replicate events such
as geriatric depression screenings.
State’s Vision for the Future of the Adult System. Oklahoma’s vision for a transformed mental health and
substance abuse delivery system is that all citizens will prosper and achieve their personal goals in the
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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community of their choice. Current Commissioner Terri White frequently emphasizes to all audiences that
“Recovery is a reality in Oklahoma!” To achieve this vision, the state developed a comprehensive plan as a
roadmap for full scale transformation. Oklahoma’s transformation involves more than improving the
traditional delivery of substance abuse and mental health services. Transformation means that the general
public will understand that mental health and freedom from addiction are essential to overall health. It means
Oklahomans will acknowledge that people with mental illness and addictive disorders can and do recover
and that recovery is not age-limited. It means that mental health and substance abuse services will be
driven by consumer and family needs that focus on prevention, building resilience and facilitating recovery.
Transformation will require new attitudes, behaviors, and strategies to address long-standing deficiencies
that make change difficult. Solving these problems requires time and, most importantly, requires active,
committed, and sustained leadership.
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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System Strengths, Needs, and Priorities - continued
Children
Child Service System’s Strengths and Challenges. The following items are summarized from the Needs
Assessment and Resources Inventory Report completed in connection with the transformation activities.
Strengths (Child System)
• Substantial cross-agency collaboration and policy developments.
• Specific to the cross-agency collaboration are the resources contributed by multiple state agencies in
the form of upper level management staff to meet regularly to address, plan, and implement systemic
changes.
• Continued growth of Systems of Care (SOC) sites have carried with them values that infuse energy
and focus in all child-serving systems. The wraparound service model has been a framework to
exemplify and sustain these values.
• Oklahoma’s significant involvement with the National Child Traumatic Stress Disorder Network.
��� Growing collaboration to strengthen services to younger children and address early identification,
intervention, and early service needs.
• A strategic funding plan to expand a continuum of services and coordinate resources across all child-serving
agencies.
• Growing collaboration to address the needs of transitional age youth.
• A vibrant youth-led leadership development program for youth impacted by serious emotional
disturbance (SED).
• Initiatives beyond the ODMHSAS through the Oklahoma Department of Human Services (OKDHS)
and the Office of Juvenile Affairs (OJA) to implement evidence-based and trauma-informed programs
within these child-serving systems.
• Expansions supported by the state Medicaid authority to assure health care, including behavioral
health services, to an increased number of children and their families.
Challenges (Child System)
• Significant gaps exist between the estimated prevalence of children in need of mental health
services and the capacity of the state to respond, in spite of exemplary systemic collaboration and
improvements. The number of children eligible for services is expanding at a faster pace than the
availability of public resources.
• The lack of accessible community-based services.
• The lack of early access options for intervention and prevention for families and their children.
• The growth of non-English speaking families is disparate with the availability of linguistically matched
workforce.
• Transportation to access services preferred by families which are not available in all communities.
• Transition issues for youth as they “age out” of the child system without systemic interface with the
adult system.
Unmet Service Needs. (Child System) The previous section on Children’s Service Systems Strengths and
Challenges highlights these. The source of the data is the Needs Assessment and Resources Inventory
Report, completed in 2006 as part of the state’s transformation initiative.
Plans to Address Unmet Needs. (Child System) As referenced earlier, the Oklahoma Comprehensive Plan
for Substance Abuse and Mental Health Services, developed in 2006 as transformation activities established
a framework to address unmet needs. The plan was recently updated to reflect selected priorities.
Initiatives that will address the needs of children, youth, and families are listed below.
• Develop an anti-stigma campaign targeted for staff of state agencies.
• Develop a care coordination initiative to increase community tenure for youth with high propensity
for out-of-home placement.
• Train staff in cultural competency.
• Develop partnerships with universities for child psychiatric fellowships.
• Develop telehealth network to improve access to care for rural Oklahomans.
• Fund Consumer, Family, and Youth Leadership Academies.
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• Develop partnerships with Latino agencies to improve access to care for Spanish speaking
individuals with behavioral health needs.
• Provide incentives for behavioral health screenings in primary care settings.
• Fund designated staff to build the Infant and Early Childhood infrastructure.
• Develop funding for university students and researchers to conduct evaluations relevant to the
behavioral health field.
Recent Significant Achievements. (Child System) Oklahoma’s well established foundation of
partnerships and shared vision among major stakeholders continues to shape and improve the overall
service delivery system for children and their families. Some are highlighted in this section.
Partnership for Children’s Behavioral Health (PCBH). This partnership continued as a proactive
force on behalf of children in 2008. The PCBH is comprised of the directors of the eight children serving
state agencies, five parents of children with serious emotional disturbance (SED), advocacy
representatives, and two state legislators continued to be active. All members were appointed by
Governor Brad Henry in response to a Memorandum of Agreement developed as part of a Children’s
Behavioral Health Policy Academy in 2003. Most members of the Partnership continue to also serve on
the Governor’s Transformation Advisory Board. Partnership members meet as a separate body as
needed to address issues specific to children, youth, and their families. Recent actions taken by the
Partnership are described below.
The PCBH approved plans for a coordinated children’s budget request for the 2008 Legislative Session.
The request was not funded due to limited state revenues. However, the Legislature and other
constituencies considered the multi-agency initiative as noteworthy and encouraged the partners to
continue similar activities and requests in the future.
Partnership members submitted a proposal to the Center for Medicare and Medicaid (CMS) to support
the development of an outpatient care coordination system for children eligible for residential care
(Alternatives to Inpatient Treatment). The proposed model was patterned after a 1915C waiver.
Although this proposal was not accepted, a care coordination project is going forward using TSIG
funding. Personnel located in OHCA, the ODMHSAS and the Oklahoma Federation of
Families/Evolution Foundation (OFF/EF) will work together to ensure the children, youth, and families
accepted into the project receive seamless services across the continuum of care, with a target of no
more than a two week gap in services after hospital discharge to the first community based service.
There will be a formal evaluation of this project conducted by the University of Oklahoma Educational
Training, Evaluation, Assessment and Measurement (E-TEAM) staff.
Collaboration continued among the Oklahoma Department of Human Services (OKDHS), Office of
Juvenile Affairs (OJA), Oklahoma Health Care Authority (OHCA), Oklahoma Commission on Children
and Youth (OCCY), National Resource Center for Youth Services (NRC), the ODMHSAS, private group
home contractors, and private hospital based providers to improve the skill set of direct care staff by
providing trauma informed training in Systematic Training to assist in the Recovery from Trauma
(START). The goal is to reduce the incidence of seclusion and restraint, provide more individualized
services to children in care, and provide group home staff with technical assistance, training, and support
through consultation services provided by the ODMHSAS and the National Resource Center for Youth
Services.
The PCBH supported the implementation of training using the curriculum developed for Family Support
Partners (providers). Fifty-five family members have been trained to date in this curriculum. Partnership
activities all assisted the Oklahoma Systems of Care state staff and the Oklahoma Federation of
Families to implement a toolkit for local community development. An update to the toolkit is planned for
fall 2008.
Expansion of the statewide Systems of Care continued to closely align with PCBH activities. There are
local Systems of Care in operation and additional communities are under development.
The OKDHS and the ODMHSAS provided leadership within the PCBH to better support transition of
youth with serious emotional disturbance from the child serving system to the adult mental health serving
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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system. The ODMHSAS funded six pilot sites statewide to provide vocational, care management, and
housing referral support to youth ages 17 – 24. Oklahoma’s application for the 2008 National Policy
Academy on Youth and Young Adults in Transition was recently selected for funding. The state intends
for this Academy to launch a more concerted effort on behalf of youth and young adults.
Federation of Families for Children’s Mental Health. The ODMHSAS continued to contract with the
Oklahoma Federation of Families/Evolution Foundation (OFF/EF), the State’s Federation affiliate, to
provide statewide advocacy and education in support of children with SED and their families. There are
currently 26 active local family groups that provide support and education as peer families. They also
advocate for specific families when needed and actively advocate for a family driven system. They have
been instrumental in the development of numerous Systems of Care communities throughout the state.
In addition, the ODMHSAS contracts with OFF/EF to provide technical assistance to the thirty- six
operational Systems of Care sites in Oklahoma, including strategic planning, community readiness, and
new site development.
Prevention and Early Intervention Activities. Suicide prevention, early childhood assessments, and
targeted activities related to infant mental health have increased. Also, Governor Brad Henry formed a
task force that subsequently formulated recommendations for more proactive approaches to address the
needs of youth and young adults in the state’s higher education community. Related to this, the
University of Central Oklahoma recently announced its commitment with the new academic year to be
Oklahoma’s first prevention-oriented campus. This proactive approach more closely and effectively
aligns behavioral health and security needs in the higher education setting.
Exemplary Treatment for Children
• The ODMHSAS Director of the Office of Children Youth and Families provides visible and broad
based representation from the ODMHSAS in numerous settings where children’s services are
discussed. This individual also serves as Principal Investigator for Oklahoma Systems of Care.
Partnerships emerging from these activities have greatly enhanced the state’s Systems of Care
activities. There are currently 36 local Systems of Care statewide. Additional communities are in a
strategic readiness/development phase, however, due to a flat budget year for Oklahoma, there
was no new funding for communities this year.
• The ODMHSAS supported training of children’s mental health workers through the Department’s
regular Donahue Series and the Annual Children’s Conference. The Children’s Conference
typically attracts 800 to 1,000 participants each year. There is a robust Oklahoma Systems of
Care annual training program coordinated through the Office of Children, Youth, and Families
(attached). Wraparound training is augmented through a statewide coaching system. This system
is headed by two full-time trainers/coaches. There is a new certification program for wraparound
facilitation. Additionally, there is a specialized curriculum for family support providers and for
behavioral health aides. Through contracts with the University of Oklahoma, ongoing training is
available to clinicians in trauma-focused cognitive behavioral therapy and Parent Child Interaction
Therapy at no charge to the clinicians.
• Since 2005, the ODMHSAS has received an annual state appropriation of $500,000 to provide
Counseling services for children and youth who have been trauma-exposed. Contracts have
been issued to eight domestic violence shelters, three CMHCs, and to the Latino Community
Development Agency. Two of these contracts are specifically targeted for Spanish-speaking
families. Trauma-focused cognitive behavioral therapy will be the central evidence-based
intervention for these services. The Women In Safe Home, Inc. (WISH) project also partners with
a CMHC, Green Country Behavioral Health to utilize Dr. Bruce Perry’s training and approach in a
therapeutic head start program.
• The legislature targeted additional funds beginning in state FY07 to increase services to children
and youth in partnership with schools and/or child care centers. Eight agencies were selected to
plan and deliver increased services to children and youth through this program. The centers are
in Ponca City, Muskogee, Oklahoma City, Tulsa, Woodward, Lawton, and the area including
Beckham, Custer, Roger Mills, and Washita Counties. National experts held one-day trainings for
program staff in Positive Behavioral Interventions and Supports (PBIS), a best practice model for
partnerships with schools.
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Transition Services. The legislature appropriated over $600,000 in state FY07 to fund an array of
services for transitional age youth, including wraparound, housing subsidy, and employment/education
assistance. Funding continues as part of the ODMHSAS base budget. Six sites were selected to initiate
programs for this age group which now includes youth ages 17 – 24. OKDHS has assigned a
representative in each region to work specifically with the youth in these programs. All programs are
receiving training in best practice, Transition to Independence Programs (TIPS) and in the wraparound
model. Training began with Dr. Rusty Clark and Dr. Nicole Deuschenes from the University of South
Florida. Housing subsidies are brokered through one CMHC but available in all transition pilot sites.
Crisis Centers. In state FY07, the legislature appropriated in excess of $1.5 million for additional
regional crisis stabilization facilities (24 hour behavioral health crisis response for children and youth,
ages 10 to 18). Two CMHCs were selected to develop the programs: Associated Centers for Therapy in
Tulsa and Green Country Behavioral Health Services in Muskogee. Unfortunately, one of the centers,
Green Country, has closed due to never building a census that would support the cost of operation.
Mobile Crisis Response (MCR) Services. The state FY07 appropriation increase also included
$850,000 for mobile crisis teams for mental health and substance abuse emergency services for children
and youth. Nine mobile crisis teams were active in state FY08, six of which were located in rural areas.
A training package has been designed to train in best practices for crisis response. The ODMHSAS also
hired an Access Specialist to monitor program start up and fidelity on an ongoing basis. Teams provide
outreach, assessments, evaluation, crisis intervention and stabilization, referral, crisis planning, 24-48
hour follow-up appointments, short term therapy, and/or monitoring for individuals experiencing a mental
health or substance abuse emergency. MCR teams respond to crises in the community, at schools,
hospitals, shelters, places of employment, and other community settings to stabilize the situation in the
youth’s natural environment. MCR services are designed to de-escalate the crisis situation, prevent
possible inpatient hospitalization, detention, homelessness, and restore youth to a pre-crisis level of
stabilization. Services are tailored to youth and their families and focus on family strengths, needs, and
preferences. While all MCR teams have the same goals and objectives, each community has their own
specifications to best meet the needs of the consumers in their communities.
FFY2010 Application Updates: Updates related to the Transformation State Incentive Grant,
Telemedicine, Integrated Payment and Information Systems, and Medicaid are included in the Adult
plan but all of these will continue to positively impact services for children and their families. Additional
transformation activities are described in the following updates.
Medicaid. The Center for Medicaid and Medicare Services (CMS) recently approved a revision to the State
Plan to reimburse the ODMHSAS-credentialed Peer Recovery Support Specialists and Family Support
Providers.
Partnership for Children’s Behavioral Health (PCBH) and Systems of Care. The PCBH continues to
work within the Governor’s Transformation Advisory Board (GTAB) and is functions as a separate group as
needed to specifically focus transformation activities on the needs of children, youth, and families. The
Systems of Care continue to grow in Oklahoma. Oklahoma completed year six of a Systems of Care grant
funded by the CMHS Comprehensive Community Mental Health Services Program for Children and Their
Families initiative. In 2009, Oklahoma was awarded an additional six-year grant to further expand systems
of care statewide and also focus on specifically underserved populations. Currently 40 counties are served
by local Systems of Care. A new project has begun with the Indian Health Care Resource Center in Tulsa in
FY09. In 2010, six additional communities will come on line. The state is on track for all 77 counties to be
served by local Systems of Care teams by 2013.
The PCBH has been the foundation and coordination stimulus for significant interagency initiatives to
enhance services to children with serious emotional disturbances and their families. Following are
examples of recent activities that will continue in 2010.
OKDHS, ODMHSAS, OSDH, and OCCY collaborated with Oklahoma Association for Infant Mental Health to
develop a program to “endorse” child care workers, educators, and mental health professionals receiving
specific training in infant mental health. Endorsement is available at four levels, beginning with child care
providers.
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DMHSAS, OSDH, and OKDHS also collaborated to provide TA and consultation to child care providers who
contact the state’s child care warm-line to facilitate early intervention among children ages birth to 5 years
old with challenging behaviors.
OHCA and OKDHS are collaborating with the OU Health Sciences Center to create specialized “medical
homes” for children in foster care and adoption.
Seven agencies participated to develop a coordinated budget request for children’s behavioral health which
was a five year plan that encompassed the spectrum from prevention, early intervention, community-based
services, all the way to inpatient and residential treatment.
The ODMHSAS utilized the SAMHSA TSIG dollars to fund a pilot project at the Neonatal Intensive Care Unit
at the University of Oklahoma Health Sciences Center to screen new mothers, provide brief intervention and
refer to further treatment when needed.
Additional initiatives within the ODMHSAS will support the agency’s intent for a broader approach to serving
children, youth and families. These included SBIRT screening in hospital emergency rooms, Mental Health
First Aid training, and improved contract language to encourage CMHCs to broaden their treatment
programs to include a more holistic approach toward wellness and recovery.
Prevention and Early Intervention Activities. Much of the work of the PCBH continues to focus on early
intervention activities to more effectively identify needs and provide services for younger children. The TSIG
also funds a position at the State Department of Health (SDOH) dedicated to infant mental health. The
ODMSHAS Prevention Division received additional grants this year to focus on elimination of underage
drinking, methamphetamine prevention, and early screening and suicide prevention activities.
FFY2011 Application Updates:
Partnership for Children’s Behavioral Health (PCBH) and Systems of Care. As referenced earlier, state
revenues were drastically diminished in 2010. This will also impact budgets for FY2011. Consequently, the
state has not been able to move forward with an expanded coordinated budget request across multiple
agencies. However, the ODMHSAS avoided what could have been devastating reductions in specific
funding for children’s behavioral health services. Stakeholders, including the Oklahoma Federation of
Families, and local communities systems of care advocated effectively with the legislature to minimize the
impact of budget reductions for mental health and other services.
Transformation Initiatives. A pilot was conducted in 2010 to determine if intensive care coordination by
phone from the Oklahoma Health Care Authority (OHCA) – the state Medicaid agency-- would improve
outcomes for children. The pilot was designed to improve coordination of care for children between inpatient
and outpatient service settings and to monitor that care coordination on behalf of the children and their
families. Data demonstrated more than adequate cost savings. Efforts are underway to sustain funding for
this beyond the pilot phase. Some of this work was initially funded through SAMHSA State Transformation
Incentive Grant (TSIG). TSIG also coordinated with the Oklahoma State Department of Health (OSDH) to
coordinate evidence based early childhood prevention and early intervention activities in 2010. .
Other Developments. Additional SAMHSA grant funds were awarded to Oklahoma in FY2010 for initiatives
included in the Partnership for Children’s Behavioral Health (PCBH)/TSIG strategic plan. The Oklahoma
Healthy Transition Initiative (OHTI) is described in a FY2011 Application Update under Criterion 3. The
Statewide System of Care Expansion grant is described in a FY2011 Application Update under Criterion 4.
Both projects are multi-year and have provided significant resources so Oklahoma can continue to improve
the range and effectiveness of services available for all children, youth, and their families. The state applied
for numerous additional Federal grants that, if awarded, will continue to support Oklahoma in 2011 and
beyond to improve services and outcomes for children needing treatment and supports.
State’s Vision for the Future of the Child System. The vision for Oklahoma’s comprehensive system to
address the needs of children with mental health and substance abuse disorders and their families is the
same as that summarized in the Adult Plan - all citizens will prosper and achieve their personal goals in the
communities of their choice. The state’s comprehensive plan addresses the entire life span, prevention, and
integration with overall health. Specific strategies to impact the needs of children and their families are
identified in that comprehensive plan. See http://www.okinnovationcenter.org.
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State Mental Health Plan
Adult Plan �� Description of Services
Criterion 1 (Adult Plan): Comprehensive Community-Based System of Care for Adults
Fifteen publicly funded community mental health centers (CMHCs) serve the state with programs established
in approximately 70 cities and towns. Department employees operate five of the publicly funded centers in
Lawton, McAlester, Norman, Tahlequah, and Woodward. The others are private, nonprofit organizations
contracting with the Department. In addition, the Department operates the Oklahoma County Crisis
Intervention Center (OCCIC) and the Tulsa Center for Behavioral Health (TCBH). OCCIC and TCBH provide
intervention, stabilization, and referral for residents who experience mental health or substance abuse
emergencies in the Oklahoma City and Tulsa metropolitan areas. The TCBH also initiated an Integrated
Dual Diagnosis Treatment residential unit in 2004. The adult system has also expanded to proactively
support diversion from the criminal justice system. Initiatives within this realm include twelve mental health
courts, a day reporting center in Oklahoma City, jail-based screenings in both Tulsa and Oklahoma City,
statewide training in the Memphis Model CIT program, prison-based dual treatment for co-occurring mental
health and substance abuse disorders, prison-based discharge planners, and community-based Re-entry
Intensive Care Coordination Teams.
Community mental health centers served 39,545 adult clients – 63.9 % of the total clients served with
Department funding during fiscal year 2008. Children under 18 accounted for 12.7 % of mental health center
clients, while 1.5 % were older than age 65. Nearly 4,100 of community mental health center clients were
diagnosed with both a psychiatric disorder and an addiction to alcohol or other drugs.
FFY2010 Application Updates: Community mental health centers served 39,545 adult clients – 63.9 % of
the total clients served with Department funding during fiscal year 2009. Children under 18 accounted for
12.7% of mental health center clients, while 1.5% were older than age 65. Nearly 4,100 of community
mental health center clients were diagnosed with both a psychiatric disorder and an addiction to alcohol or
other drugs.
FFY2011 Application Updates: Community mental health centers served 45,816 adult clients – 85% of the
total mental health clients served with Department funding during fiscal year 2010. Children under 18 (6201)
accounted for 12% of mental health center clients, while (909) 1.7 % were older than age 65. Nearly 3,300
community mental health center clients were diagnosed with both a psychiatric disorder and an addiction to
alcohol or other drugs.
Services Available for Adults. The following sections describe the array of services available in Oklahoma
for adults. This includes a description of case management services, psychosocial rehabilitation, resources
available for housing, education and employment, access to medical, vision, dental, peer advocacy, and
family support. The state’s efforts to reduce the utilization of hospitalization are discussed.
Mental Health and Rehabilitation Services. The following basic services are provided by each CMHC.
• Crisis intervention
• Medication and psychiatric services
• Case management services
• Evaluation and treatment planning
• Counseling services
• Psychosocial rehabilitation services
Employment Services. Employment and employment assistance continues to be in high demand among
consumers and advocates. Vocational services for persons with a serious mental illness continue to
be provided at three locations. Supported Employment services are currently provided at Green Country
Community Mental Health Center, Crossroads Clubhouse and Thunderbird Clubhouse. The Department of
Rehabilitation Services (DRS) and the ODMHSAS jointly fund these programs. DRS provides funding for
supported employment, transitional employment, and job placement. The ODMHSAS funds job retention
services and basic community mental health services.
DRS utilizes a performance-based funding system paying providers for each completed step, termed
“milestones.” The largest payments are provided for job placement and ninety-day job retention. CMHCs
historically found the milestone system a challenge given limited resources to initiate programs without start-
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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up funds, and the way the milestone payments were weighted. The ODMHSAS and DRS evaluated the
existing milestone system and its effectiveness in serving people with mental illness. As a result, a new
milestone configuration was proposed and approved by the DRS Board to be utilized for specialized mental
health supported employment best practices contracts.
The Interagency Coordination Committee composed of consumers, family members, direct line staff, and
CMHCs was established in 1998 to provide oversight to the interagency agreement between the ODMHSAS
and DRS. The Interagency Committee, in partnership with other community stakeholders, is currently
facilitating and monitoring implementation of the SAMHSA Evidenced Based Practice (EBP) toolkit for
Supported Employment. DRS has awarded two CMHCs start up funds as model sites for implementation
of the Supported Employment EBP, and the CMHCs should receive those funds within the next couple of
months.
Housing Services. Assuring satisfactory access to comfortable and preferred housing for adults with
mental illness continues to be a challenge to the state. This continues to be an unmet need for many adults
with mental illness and the state is challenged to identify additional resources and options for housing.
Although the needs are great and unmet, a variety of options are in place. Specialized housing for people
with mental illness are located in both urban and rural settings and are funded through the ODMHSAS,
Housing and Urban Development (HUD), public housing authorities, and private sources. Housing models
include transitional housing and permanent supported housing (both congregate and scattered site).
Although some specialized housing specifically for persons with mental illness continues to be developed
(i.e. HUD funded Section 811 and HUD SHP projects), the ODMHSAS has placed an emphasis on creating
opportunities for more integrated housing and specifically on permanent scattered site housing with available
housing support services. Some stakeholders continue to encourage the development of transitional
housing services to meet the needs of consumers whose current level of recovery would make it difficult to
have success in a supported housing model.
The ODMHSAS continues to subcontract with designated CMHCs to implement HOME Program Tenant
Based Rental Assistance (TBRA) projects to very low income persons with mental illness (including those
with zero income) in rural Oklahoma. This rental assistance serves as a bridge subsidy and is transitional in
nature; a maximum of 24 months. The goal of the project is to assist participants’ access and maintain
permanent housing while they are waiting to acquire long term subsidy like Section 8, and/or are working to
increase their income either with SSI/SSDI or employment. Program services include both rental assistance
and supportive services. The ODMHSAS has written for another HOME Program TBRA grant through the
Oklahoma Housing Finance Agency with hopes of continuing this assistance in the coming years.
All CMHCs receive flexible funds from ODMSHAS. These funds may be used to secure independent
housing for clients by paying first month rent, utilities and other initial move-in expenses, and to prevent
homelessness through short term payment of rent and utilities to help avert eviction.
The ODMHSAS also funds a Discharge Planning Housing Subsidy program to assist very low-income
individuals (age 18 and older) with mental illness or co-occurring mental illness and substance abuse
disorders who are discharging from psychiatric inpatient care, Department of Corrections, or aging out of the
foster care system, with accessing and maintaining decent and affordable housing. Participants must be
homeless or at risk of becoming homeless without rental assistance. Funds assist with rent, utility costs, and
deposits. The amount and type of assistance is based on individual income and identified need. This
subsidy is tenant based.
The ODMHSAS funds a Transition Youth Housing Subsidy program to assist very low-income individuals
(ages 17 - 24) with mental illness or co-occurring mental illness and substance abuse disorders who
participate in the employment Transitions Project. Funds are used for rent, utility costs, and deposits. The
amount and type of assistance is determined based on individual income and need. This program is also
tenant based – provided for housing selected by the program participant.
Other Housing Services. Residential care facilities (ResCares) are a major source of housing for persons
with mental illness. In FY08, 1,413 ODMHSAS clients resided in 29 ResCares, about 4.2 % of the total
population with Serious Mental Illness (SMI) served by the ODMHSAS. The ODMHSAS ResCare funding
includes an incentive structure by which homes can receive a higher rate for services if they successfully
meet criteria for designation as a Recovery Home. The criteria focus on providing residents increased
opportunities for independence, self-direction, and community integration.
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As a new initiative, the ODMHSAS will issue a Request for Proposal (RFP) in state FY09 for ResCares to
provide transition services to assist residents of ResCares with moving into permanent housing in the
community and successfully linking with community supports. Transformation Incentive Grant Funds will be
utilized to provide needed training and infrastructure building within the ResCares selected for this initiative,
and state appropriations will be used to fund the actual transition services.
Education. Some education services for adults are provided through the Department of Rehabilitation
Services supported education program. DRS funds support case management activities for individuals with
disabilities attending school. Adult basic education is also facilitated through clubhouse and general
psychosocial rehabilitation programs at the CMHCs. CMHCs and other providers advocate on behalf of
service recipients/students to secure grants, loans, and other supportive services to access educational
opportunities.
Substance Abuse Services. Ninety-one ODMHSAS-affiliated programs served 20,688 clients in state
FY08 at over 197 sites throughout the state. Approximately 10% of these clients served were under age 18.
Programs offer a range of services including assessment and referral, detoxification, outpatient counseling,
residential treatment, transitional living, and aftercare. All community mental health centers are certified as
substance abuse service providers and received both mental health and substance abuse funding to serve
persons with serious mental illness and co-occurring substance abuse disorders. Specialty substance
abuse treatment providers also collaborate with local community mental health centers for mental
health assessment and other CMHC-based services as needed by consumers. Individualized, gender and
culturally-specific substance abuse treatment was required of all providers. Consumer employment,
education, housing and other needs are assessed by substance abuse providers and case management is
provided as needed to address related issues that might otherwise lead to relapse.
Medical, Vision, and Dental Services. Case management services continue to be the link to medical,
vision, and dental services for many adult consumers. Access is more likely for Medicaid beneficiaries.
Other resources are available for the non-Medicaid population. The University of Oklahoma Health Sciences
Center (OUHSC) in Oklahoma City and the University of Oklahoma Tulsa-College of Medicine provide
indigent medical care. Increased collaboration has also developed in some areas of the state with Federally
Qualified Health Centers. Many communities rely on local resources for health care such as the Indian
Health Service, clinics, homeless clinics, county health departments, and pro bono health care providers.
Dental services are also provided in local communities through free dental clinics and pro bono providers.
Dental services are also available in the state hospitals. Community mental health centers are encouraged
to use the ODMHSAS flexible funds to purchase individual medical, vision and dental services for
consumers.
Support Services and Psychiatric Rehabilitation. All ODMHSAS-certified CMHCs must provide either
Clubhouse or a general psychiatric rehabilitation program. Clubhouse programs must also be certified by
the International Center for Clubhouse Development (ICCD). Two clubhouses (Crossroads Clubhouse and
Thunderbird Club) are currently ICCD-certified. There are currently 44 general psychiatric rehabilitation
programs across Oklahoma operated within the service regions for 15 Community Mental Health
Facilities. During state FY08, four programs became model sites and implemented the Illness Management
and Recovery (IMR) evidence based practice. In FY09 these four sites as well and other programs will
participate in a research project to compare the IMR’s effectiveness at assisting people with recovery. The
project will evaluate the impact of IMR on recovery as reported by consumers. This will be funded, as part of
the TSIG evaluation activities. The IMR Implementation Steering Committee, along with other stakeholders,
will serve as the Research Committee.
Case Management. Oklahoma views behavioral health case management as a service that is essential to
the recovery process for adults with serious mental illness. Behavioral health case manager’s help
participants develop networks of natural and formal supports/resources necessary to live in the communities.
During state FY08, behavioral health case management services totaled approximately 102,000 hours for
adults.
Case management is funded both by the ODMHSAS and the Medicaid program. The definitions differ
slightly between the two funding sources, but the basic values and purposes are identical. The ODMHSAS
continues to use the strengths based model of case management. The OHCA (Medicaid) has recently
incorporated strengths based terminology and expectations in its regulations. All case managers must
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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complete a specified curriculum and examination to be eligible for reimbursement from the ODMHSAS and
the state Medicaid agency. In state FY03, statutory authority, as an official Certification, formalized this
training. By July 1, 2008, approximately 1,400 individuals had satisfied basic requirements to be Certified
Behavioral Health Case Managers. A dedicated website is available to provide access to the ODMHSAS
certification information for case managers. (See http://www.odmhsas.org/CaseMgnt.)
To increase the workforce of case managers, the ODMHSAS and the OHCA collaborated to provide multiple
entry points to becoming certified. The ODMHSAS also reorganized the training and provides options for on-line
training of specific elements as well as the ability to test at numerous locations statewide to qualify for
provisional status as reimbursable case managers. In order to increase the workforce of Certified Behavioral
Heath Case Managers, the ODMHSAS has recognized the value of potential workforce members who
have case management life experience and opened up certification to people who have completed 60
college credit hours or a high school diploma with 36 total months of experience working with persons who
have a mental illness.
Case management activities may take place in the individual’s home, community, or a facility. A Certified
Behavioral Health Case Manager, in accordance with a treatment plan developed and approved by the
service recipient and qualified staff must provide the services. Billable activities include linkage with
appropriate components of the service system, support to maintain community living skills, and contacts with
other individuals and organizations that influence the recipient’s relationship with the community, i.e., family
members, law enforcement personnel, landlords, etc.
The ODMHSAS, the Governor's Interagency Council on Homelessness, the Oklahoma Social Security
Administration, and the Oklahoma DRS Disability Determination Division continue to sponsor statewide
Social Security (SSI/SSDI) Outreach, Access and Recovery (SOAR) training. SOAR is specialized training
utilizing Stepping Stones to Recovery: A Case Manager's Training Curriculum for Assisting Adults Who are
Homeless, with Social Security Disability and Supplemental Security Income applications developed by the
U.S. Department of Health and Human Services. Nearly 500 people have received the training to date. The
ODMHSAS and Oklahoma DRS Disability Determination Division staffs serve as SOAR trainers. This
training initiative, along with other inter-agency collaborative efforts, have resulted in an increase of benefits
approval on initial application from 31% to 55% and a decrease in processing time from 132 days to 62
days.
Services for Persons with Co-Occurring Disorders/Integrated Services Initiative. The ODMHSAS has
utilized funding through the SAMHSA Cross Training Initiative, a Co-Occurring Policy Academy, and the Co-
Occurring State Incentive Grant (COSIG) to build a more robust network of treatment providers to more
effectively provide services to persons with both mental illness and substance use disorders. Funding for
that initiative will soon expire. Regardless, the products developed through this initiative will continue to
impact the service infrastructure changes to provide more effective integrated treatment services. Examples
of the results of the initiative are included below.
• An integrated assessment process that includes mental health, substance abuse, and trauma.
• Core and intermediate co-occurring disorders trainings.
• Administrative code and contract changes to specifically require and support an integrated treatment
approach.
• A revised contract format for CMHCs to more clearly support integrated treatment and braided
funding to service adults and children with co-occurring disorders.
• Twelve-step oriented peer support for person with co-occurring disorders (Double Trouble in
Recovery) on a statewide basis.
Other Activities Leading to Reduction of Hospitalization. The ODMHSAS culture embraces strengths
based and consumer centered approach which expects service providers, consumers, and their support
systems to clearly identify resources and factors needed for community success and thereby reduce the use
of hospital or other institutional-based resources. CMHCs are monitored to assure that services include
cooperative discharge planning with inpatient programs and crisis units, early response and crisis
intervention programs, and community partnerships with law enforcement. A network of crisis intervention
centers is in place to provide short term stays and stabilization in lieu of placement in inpatient facilities. The
proven models, such as Crisis Intervention Training (CIT), PACT, and newly developed Intensive Care
Coordination Teams (ICCT) are designed to provide intervention, coordinated care, and successful
community integration. Recent enhancements in terms of early intervention and transitional services on
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
31
behalf of persons who interface with the criminal justice system will also prevent the use of hospitalization as
well as incarceration.
FFY2010 Application Updates: Enhanced Payment System. The ODMHSAS utilized a limited funding
pool in FY2009 to develop the Enhanced Tier Payment System (ETPS) for CMHCs. Centers that met
established targets earned additional money based on their performance outcomes. For every state dollar
contributed to the ETPS, the federal government contributed approximately two additional dollars through the
Medicaid matching agreement. With federally matched funds, ODMHSAS was returned in excess of
$6,000,000 to the CMHCs for additional services. The following measures, some of which are closely
aligned with the National Outcome Measures (NOMs), were the focus of the ETPS:
Outpatient Crisis Service Follow-up within 8 Days - the number, per month, of outpatient crisis service events
that were followed-up by an outpatient non-crisis service within eight days.
Inpatient/Crisis Unit Follow-up within 7 Days - the number of inpatient/crisis service events that were
followed-up by either outpatient or housing services within seven days of referral.
Reduction in Drug Use - the number of individuals who reported a reduction in drug use/abuse use over a
seven month period.
Engagement: Four Services within 45 Days of Admission - the number of times a client received at least four
services within 45 days of the start date of an outpatient episode.
Medication Visit within 14 Days of Admission - the number of times a medication visit occurred within 14
days of each admission.
Access to Treatment - the interval between initial contact and receipt of treatment services.
Hospitalization decreased and utilization of community based services increased as a result of this initiative.
FFY2011 Application Updates: Enhanced Tiered Payment System. In coordination with the statewide
CMHC network, additional measures were designed and implemented in FY2010. Reporting and monitoring
continued. The amount of funds available for payments was decreased due to state budget shortfalls. The
additional measures are listed below.
- Improvement in CAR Domain Interpersonal
- Improvement in CAR Domain Medical/Physical
- Improvement in CAR Domain Self Care/ Basic Needs
- Inpatient/Crisis Unit Readmission within 180 Days
- Outpatient Peer Recovery Support
- Access to Treatment for Children
Criterion 2 (Adult Plan): Mental Health Epidemiology Data
Estimation Methodology. Oklahoma's estimate of prevalence of adults with a serious mental illness (SMI)
is based on federal guidelines from the Center for Mental Health Services, published March 28, 1997 (using
1990 census data). Data from two major national studies, the National Comorbidity Survey (NCS) and the
Epidemiologic Catchment Area (ECA) Study, were used to estimate the prevalence of adults with serious
mental illness. The estimated prevalence for adults with SMI is 183,366. In state FY08, the ODMHSAS
served over 31,000 adults with serious mental illness or 16.5% of the estimated SMI population.
FFY2010 Application Updates: In State FY09, the ODMHSAS served 37,393 adults with serious mental
illness or approximately 16.5% of the estimated population with SMI.
FFY2011 Application Updates: In state FY10, the ODMHSAS served 41,408 adults with serious mental
illness or 21.2% of the estimated SMI population.
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
32
Quantitative Targets for Adult Service System. Quantitative targets in terms of numbers of persons
projected to be served are detailed in the goals sections of the plan. Briefly, the state proposes to increase
the number of persons served by 6%, pending significant changes in resources, in the years encompassed
by this Plan.
Criterion 3. (not applicable to Adult Plan)
Criterion 4 (Adult Plan): Target Populations
Outreach to Adults Who are Homeless.
The table below reflects the geographic distribution of homeless individuals in Oklahoma. This information is
based on the 2006 point-in-time surveys done by each of the state’s Continuums of Care (statewide 2008
point-in-time survey data are not yet available). The estimation of homeless people with serious mental
illness is based on the number of homeless individuals who identified themselves as someone with a mental
illness during the point-in-time surveys. The numbers in the table below reflect an estimated 27% of the total
homeless population. Individuals in imminent risk of becoming homeless are not included in these data.
Geographic Regions In
Shelters
Not in
Shelters
Homeless
Population
Estimate of Homeless
Individuals with a
Serious Mental Illness
Oklahoma County* 1117 400 1517 410
Tulsa County* 568 46 614 166
Cleveland County 104 141 245 66
South West 48 ** 48 13
North West 78 145 223 60
North Central 142 36 178 48
North East * 119 238 357 96
South East 62 21 83 22
TOTALS 2238 1027 3265 881
* PATH provider locations. ** No street outreach was conducted for this region
Several initiatives are in place to identify and serve homeless individuals. Oklahoma has been awarded
PATH funds in the amount of $360,000 for state FY09. The state’s PATH programs are located in the areas
of Oklahoma with the highest numbers of people who are homeless: the two largest metropolitan areas,
Oklahoma City and Tulsa, and in the rural community of Tahlequah which is located in northeast
Oklahoma. The services provided within the PATH programs for state FY09 and the subsequent years
included in this plan will focus on intensive outreach and engagement (street, shelter, and hospital) and case
management services, including related transportation and travel. Other services will include screening and
diagnostic treatment services, habilitation and rehabilitation services, community mental health services,
including psychiatric evaluation, treatment planning and review, counseling, crisis intervention, trauma
focused treatment, pharmacological treatment, substance use treatment services, including treatment for co-occurring
mental health and substance use disorders, referral and linkages to needed health, mental health,
vocational, educational, housing services including assistance with housing security deposits, one time rental
payments, and costs associated with matching eligible homeless individuals with appropriate housing
situations.
Other Homeless Services
The Tulsa Day Center for the Homeless. This urban program provides linkages with needed mental health
and community services on behalf of adults and children who present at their site. The Day Center also
provides emergency nighttime shelter

OKLAHOMA
Mental Health Block Grant
Plan & Application
Public Comment on 2009-2011 Mental Health Block Grant Plan
This current application will be submitted in a format required by the Center for
Mental Health Services on September 1, 2010. Public comments are
requested in response to this proposed plan as described below.
1. Throughout the year, the Oklahoma Mental Health Planning and Advisory
Council (MHPAC) meets in accordance with Oklahoma’s Open Meetings
Act. Each meeting includes time for public comment on the Mental Health
Block Grant Plan for Oklahoma. Comments are summarized in Council
minutes and utilized by the MHPAC and the state throughout the year.
2. A draft of this enclosed application will be reviewed in detail at an open
meeting of the MHPAC on August 12, 2010, 10:00 am to noon in the
ODMHSAS Central Office in Oklahoma City. All present at the meeting –
including members of the public who do not serve on the MHPAC – will be
provided time to offer comments to the state and the MHPAC related to the
proposed application.
3. Oklahoma is currently operating under an approved 3-year Mental Health
Block Grant plan for FFY2009-2011. FY2011 Updates to that plan are
included in this document and are noted in the following pages as
“FFY2011 Application Updates”. To offer written comments on the
proposed application update or for additional information please contact
John Hudgens, P.O. Box 53277, Oklahoma City, OK 73152,
jhudgens@odmhsas.org or (405) 522-3800.
Formal public input will be accepted, for consideration within this application
cycle, through August 23, 2010.
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
2
OKLAHOMA
Mental Health Block Grant
Plan & Application
2009 – 2011
Submitted September 2008
UPDATES SUBMITTED SEPTEMBER 2009 AND SEPTEMBER 2010
DRAFT for Public Comment – August 4, 2010
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
3
TABLE OF CONTENTS
INTRODUCTION 4
OKLAHOMA MENTAL HEALTH PLANNING AND ADVISORY COUNCIL OVERVIEW 4
SUMMARY OF RECENT ACTIVITIES 5
DESCRIPTION OF STATE SERVICE SYSTEM 7
FIGURE 1. 7
OTHER NEW DEVELOPMENTS – SERVICES ACROSS THE LIFESPAN 10
SYSTEM STRENGTHS, NEEDS, AND PRIORITIES 15
PEER AND FAMILY ADVOCACY 17
SYSTEM STRENGTHS, NEEDS, AND PRIORITIES - CONTINUED 22
CHILDREN 22
EXEMPLARY TREATMENT FOR CHILDREN 24
STATE MENTAL HEALTH PLAN 27
ADULT PLAN – DESCRIPTION OF SERVICES 27
CRITERION 1 (ADULT PLAN): COMPREHENSIVE COMMUNITY-BASED SYSTEM OF CARE FOR ADULTS 27
CRITERION 2 (ADULT PLAN): MENTAL HEALTH EPIDEMIOLOGY DATA 31
CRITERION 3. (NOT APPLICABLE TO ADULT PLAN) 32
CRITERION 4 (ADULT PLAN): TARGET POPULATIONS 32
OTHER HOMELESS SERVICES 32
CRITERION 5 (ADULT PLAN): MANAGEMENT SYSTEMS 34
PERFORMANCE GOALS, TARGETS, AND ACTION PLANS – ADULT PLAN 38
TRANSFORMATION ACTIVITIES - ADULT PLAN 41
SUMMARY OF SELECTED TRANSFORMATION ACTIVITIES – ADULT PLAN 43
STATE MENTAL HEALTH PLAN 45
CHILD PLAN – DESCRIPTION OF SERVICES 45
CRITERION 1 (CHILD PLAN) : COMPREHENSIVE COMMUNITY-BASED SYSTEM OF CARE FOR CHILDREN. 45
CRITERION 2 (CHILD PLAN): MENTAL HEALTH EPIDEMIOLOGY DATA 47
CRITERION 5 (CHILD PLAN): MANAGEMENT SYSTEMS 52
PERFORMANCE GOALS, TARGETS, AND ACTION PLANS – CHILD PLAN 55
TRANSFORMATION ACTIVITIES – CHILD PLAN 57
SUMMARY OF SELECTED TRANSFORMATION ACTIVITIES – CHILD PLAN 57
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
4
Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011
Introduction
This Mental Health Block Grant Application and Plan has been prepared on behalf of the State of Oklahoma
in accordance with Part B of Title XIX of the Public Health Service Act. The Substance Abuse and Mental
Health Services Administration (SAMHSA) administers the grant program through the Center for Mental
Health Services. This specific block grant program supports existing public services and encourages the
development of creative and cost-effective systems of community-based care for people with serious mental
disorders. This application has been prepared in a format for public review and comment. Instructions
appear at the end of the document to guide readers in submitting comments upon their review of the
document. This particular document is organized as a 3-year plan and must be submitted to SAMHSA by
September 2, 2008.
The plan includes introductory information on the role of the Oklahoma Mental Health Planning and Advisory
Council. The actual plan is organized around key topics describing the state’s service system, including
strengths, needs, and priorities; actions proposed to continue with service improvement – including
transformation activities underway; and, targeted measures to document the state’s achievement of the
goals proposed in this plan. Content specific to adults and to children and their families is identified
throughout the document.
Readers are encouraged to review this plan with the understanding that the intent of the Mental Health Block
Grant program is to support statewide improvement, innovation, and inclusion on behalf of adults and
children in need of mental health, substance abuse, and prevention services. The Mental Health Block Grant
Plan provides a basis for future changes and is organized in a manner to accommodate annual updates and
revisions. In addition to the Mental Health Block Grant, Oklahoma is also a recipient of a Transformation
State Incentive Grant (TSIG) (see www.OkInnovationCenter.org). The state views the two federal initiatives
as complementary and has proposed this Block Grant Plan and Application in a manner to honor the value
both programs bring to Oklahoma.
Oklahoma’s vision for transformation is that all our citizens will prosper and achieve their personal goals in
the communities of their choice. This document has been developed with that vision clearly in sight.
FFY2010 Application Updates: The original plan submitted on September 1, 2008 received a 3-year
approval by CMHS without modification. This September 2009 document includes the narrative upon which
that 3-year approval was granted as well as updates to accompany Oklahoma’s application for FFY2010
funding.
FFY2011 Application Updates: This September 2010 document includes the narrative upon which that 3-
year approval was granted as well as updates to accompany Oklahoma’s application for FFY2011 funding.
Oklahoma Mental Health Planning and Advisory Council Overview
Council Duties. The Oklahoma Mental Health Planning and Advisory Council’s purpose is to (1) Review
plans, including the Federal Mental Health Services Block Grant Plan provided to the Council, and to submit
to the state any recommendations of the Council for modifications to the plans; (2) serve as an advocate in
promoting an enhanced quality of life for all adults with serious mental illness, children with an emotional
disturbance and their families, and other individuals with mental illness or emotional problems; (3) monitor,
review, and evaluate, not less than once each year, the allocation and adequacy of mental health services
within the state; and, (4) exchange information and develop, evaluate, and communicate ideas about mental
health planning and services.
Council Membership. The Council consists of no more than 35 members and is comprised of Oklahoma
residents that includes representatives of (1) principal state agencies involved in mental health and related
support services; (2) public and private entities concerned with the need, planning, operation, funding, and
use of mental health services and related support activities; (3) adults with serious mental illnesses who are
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
5
receiving, or have received mental health services; (4) the families of such adults; and, (5) families of
children with emotional disturbances.
Directors of the following state agencies appoint one member each to the Council: Oklahoma Health Care
Authority; Oklahoma Department of Rehabilitation Services; Oklahoma State Department of Education;
Oklahoma Department of Corrections; Oklahoma Office of Juvenile Affairs; Oklahoma State Department of
Health; Oklahoma Housing Finance Agency; and Oklahoma Department of Human Services.
The ODMHSAS Commissioner appoints two staff representatives, one representing mental health and one
representing substance abuse services. Boards of Directors of the following statewide advocacy
organizations also appoint one person each to serve as a Council member: National Alliance on Mental
Illness – Oklahoma; Oklahoma Mental Health Consumer Council; Oklahoma Federation of Families; and
Depression and Bipolar Support Alliance of Oklahoma.
The Commissioner of the Oklahoma Department of Mental Health and Substance Abuse Services, with
recommendations from the Council, appoints all remaining members of the Council including consumers of
mental health services, family members of adults with serious mental illnesses receiving services, family
members of children with serious emotional disturbances, providers, advocates, and other individuals
interested in the quality and effectiveness of mental health services.
Membership Terms. State agencies have permanent membership. Appointments are at the discretion of
each agency Director. Statewide advocacy organizations designated in Council Bylaws also have
permanent membership, with designees serving at the discretion of their Boards of Directors, to be verified to
the Council secretary by January 1 of each year. All other members, including consumers, family members
of consumers, and family members of children with serious emotional disorders (SED), consumer advocates,
and providers are appointed for one three-year term, with the option of a second three-year term. They can
be eligible for membership on the Council again after a 1-year break following the second three-year term.
Council Meetings. Regular meetings of the Council are held no less than quarterly. The Council typically
conducts six meetings each year. The Executive Committee may call special meetings at the request of a
majority of the members of the Council. All meetings of the Council are open to the public. Time is set aside
at all meetings of the Council for members of the public to address the Council. All meetings are announced
and posted in accordance with state open meetings law.
Summary of Recent Activities
• The Council continued to focus membership diversity in 2008. The Membership Committee, under
the direction of the Council, solicited recommendations and successfully recruited new members to
increase racial, ethnic, age, and cultural diversity as well as expanded the geographic representation
on the Council. In 2008, the Council also increased representation of parents and advocates who
speak on behalf of children with serious emotional disturbance and their families.
• The Center for Mental Health Services (CMHS) completed a site visit in June 2008, to monitor the
state’s compliance with Mental Health Block Grant requirements. During that visit, considerable time
was spent with the Council to review the Council’s functions, identify priorities of the Council, and
determine additional avenues by which the Council can impact the policy and direction of mental
health and substance abuse services in the state.
• The Council continues to have a specific representative appointed to the Governor’s Transformation
Advisory Board (GTAB) which is Oklahoma’s Transformation Working Group (TWG) as required by the
CMHS Transformation State Incentive Grant (TSIG). Other members of the GTAB are also Council
members.
• Two Council members participated in the 2008 National Joint Conference for the Mental Health Block
Grant and Statistics.
• Advocacy issues are identified by Council members and included for open discussion and fact finding
on Council agendas. Frequently, the Council will request additional information and propose actions
to proactively address the issues of concern. At the Council’s request the following items were
included as agenda presentations throughout the year. These provided opportunities for Council
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
6
members to offer suggestions, advocate for specific issues, and recommend actions to the presenters.
Advocacy issues included:
o Department of Public Safety policy regarding driver’s licenses applications (related to
persons who received treatment for a mental disorder)
o Disaster response planning
o Interagency planning and implementations related to children’s services
o Department of Corrections/adult mental health services
o Transformation updates related to the State Incentive Grant
o Peer Recovery Support Services
• The Council utilized technical assistance provided in 2007 by the National Association of Mental
Health Planning and Advisory Councils (NAMHPAC) to determine how Council priorities could be more
actively addressed through the formation of workgroups. For 2008, the following workgroups are in
place: Adult Services, Children’s Services, Older Adults Services, and Veterans Issues. In addition
the Council utilizes its Executive Committee and a Legislative Committee to assist the Council to
perform its advocacy and planning responsibilities.
• Monitoring responsibilities of the Council are frequently performed by the entire Council. The Council
identifies specific mental health and substance abuse program activities for monitoring. Specific or
representative program administrators and providers are scheduled for presentations to the Council at
regular meetings. These reports and related advocacy or other follow up activities are noted in the
Council minutes. It is anticipated, however, the above referenced workgroups will provide an additional
infrastructure through which the Council can perform monitoring. The CMHS site visit monitors
consulted with the Council in June 2008 and provided additional suggestions to the Council in terms of
the monitoring activities.
FFY2010 Application Updates: During FY2009, the Council remained active addressing its mandated
responsibilities, including additional emphasis on monitoring. The Council worked with the Deputy
Commissioner for Mental Health Services to schedule regular presentations by programs receiving MHBG
funds. Typically, a specific program was featured at each Council meeting. New members were appointed
to the Council and those new members assisted the Council in its ongoing goal to expand geographic,
cultural, and age representation on the Council, including a new youth member. The incoming Council
Chair and one other member of the Executive Committee attended the Annual CMHS MHBG/Data
Conference, June 2009 in Washington, DC.
FFY2011 Application Updates: The Council continued to fulfill all responsibilities in FY2010 related to
advocacy, planning, and monitoring. Key ODMHSAS staff participated regularly in Council meetings and
provided information and requests for guidance from the Council. Regular participants included the Deputy
Commissioner for Mental Health Services, the Director of Community Based Services (responsible for both
the child and adult systems of care), and the Director of Advocacy and Wellness. Additionally, ODMHSAS
Commissioner and Cabinet Secretary for Health, Terri White, addressed the Council, provided regular
updates to the Council through other ODMHSAS staff, and reported Council activities to the ODMHSAS
Governing Board.
The MHPAC also participated with the Coalition of Advocates on legislative, policy, and funding issues. The
Council maintained active representation on the Governor’s Transformation Advisory Board that works with
the Innovation Center in the implementation of the SAMSHA Transformation State Incentive Grant.
As in recent years, new members appointed to the Council further expanded representation, including
additional members from Tribal nations and youth representatives.
Specific to monitoring, the Council scheduled agenda items at each of its meetings during which
representatives of programs receiving MHBG funds provided updates to the members and on other initiatives
underway that enhance the broader system of care for children and adults.
The Council Chair and one other Council member attended the Annual CMHS MHBG/Data Conference,
June 1010 in Washington, DC
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
7
Description of State Service System
Overview. The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) was
established through the Mental Health Law of 1953. The law provides that all residents in the state are
entitled to care and treatment for mental illness and addiction problems in accordance with appropriate
standards of care. An eleven-member board appointed by the Governor oversees agency operations. The
Commissioner is appointed by the governing board and serves as chief executive officer. The Central Office
of the ODMHSAS is in Oklahoma City and provides the administrative, coordinating, and planning functions
of the statewide system. The ODMHSAS is the designated state authority for mental health and substance
abuse services. The mission of the ODMHSAS is to promote healthy communities and provide the highest
quality of care to enhance the well being of all Oklahomans. The ODMHSAS vision is that services will
promote productive lifestyles and set the national standard for prevention, treatment, and recovery for those
affected by mental illness and substance abuse disorders.
Delivery System. The core of the system is a network of 15 community mental health centers (CMHCs).
Ten are nonprofit agencies with which the ODMHSAS contracts and five are state-operated centers. The
state is geographically divided into 17 service areas; each served by a community mental health center (see
Figure 1.) One center serves three areas. Each CMHC is responsible to assure access to a comprehensive
array of services within a designated service area. However, individuals seeking services, in general, may
choose to seek services out of the service area in which they reside. CMHCs operate approximately 70
offices geographically dispersed throughout the state.
The ODMHSAS operates two state hospitals for adults and one children’s psychiatric hospital: the
Oklahoma Forensic Center, Griffin Memorial Hospital, and Oklahoma Youth Center. Residential care for
adults with mental illness is provided by 32 providers. The Department operates substance abuse treatment
programs within eight state operated facilitates, including some CMHCS, and contracts for services with
approximately 80 additional substance abuse treatment providers and as many as 30 separate prevention
programs. As evidence of transformation, the ODMHSAS delivery continues to operate in an increasingly
more integrated manner with collaboration and merging of functions across the realms of mental health,
substance abuse, and prevention services.
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S E RV ICE A REA 1 3
S ERV ICE S A R E A S
S ER VICE ARE A S 2, 3 , 4 , & 5
14, 18 , 19 & 20
Communi ty M ental H ealth C ente r Service Are as
Figure 1.
Infrastructure to Support the Delivery System. The Mental Health and Recovery (MHR) Division, under
the direction of the Deputy Commissioner for Mental Health, provides planning, monitoring, technical
assistance, and other support to consumers, families, and providers involved in the state-funded mental
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health delivery system. The Director of Community Based Services (CBS) and the Director of the Office of
Children, Youth, and Families report to the Deputy Commissioner and coordinate approximately 40 central
office-based employees who provide statewide support and management of the delivery system. Within the
CBS and Children’s teams are specialists in areas such as older adults, housing, employment, transition
services, case management, PACT, Wraparound Program, Peer Recovery Support, and Family Support
Services.
It is noteworthy that, during the past year, children’s services within the ODMHSAS were reorganized into the
Office of Children, Youth, and Families as referenced above. The Director of this office co-reports to the
Deputy Commissioners for both Mental Health and Substance Abuse Services. The office represents the
ODMHSAS in many partnership activities with other child-serving agencies.
Consumer/Family Support & Advocacy. The ODMHSAS Office of Consumer Affairs plays a vital role
within the delivery system by assisting with access on behalf of those requesting services as well as bringing
viable consumer voices to planning and policy discussions within the state mental health and substance
abuse authority. The ODMHSAS also continues to support the activities of the Oklahoma Mental Health
Consumer Council (OMHCC), the National Alliance on Mental Illness – Oklahoma (NAMI-OK), the
Depression and Bipolar Support Alliance (DBSA), the Oklahoma Federation of Families, and Oklahoma
Citizen Advocates for Recovery and Treatment Association (OCARTA). Consumer, family, and youth
organizations are key partners in planning, monitoring, and evaluating community-based services in
Oklahoma. The ODMHSAS Advocacy Division, established in 1990, is charged with the responsibility to
safeguard the rights of people receiving services throughout the ODMHSAS system. The Advocate
General reports directly to the ODMHSAS Governing Board and the Commissioner.
FFY2010 Application Updates: The Office of Consumer Affairs has been reorganized as the Office of
Recovery and Wellness. A director for this office joined the ODMHSAS staff in 2009 and is responsible for
expanding state level infrastructure for peer recovery support services, linkages with advocacy organizations,
and developing strategies to address overall health and wellness issues of consumers who receive services
throughout the ODMHSAS system. Integration of primary and behavioral health will be a specific focus of
this office.
FFY2011 Application Updates: In FY2010 the Office of Wellness and Advocacy developed seven
regional consumer groups throughout Oklahoma. Each group meets monthly and representatives then also
met with other groups to discuss needs, educate communities and provide feedback to the ODMHSAS.
Quarterly meetings with representatives from all regional groups were then conducted via video conference.
The ODMHSAS Office of Wellness and Advocacy also coordinated with the Oklahoma Mental Health
Consumer Council (OMHCC) to provide Key Leadership Training. OMHCC activities for this project were
funded through a SAMHSA grant to consumer organizations. In collaboration with the Department of Health,
a pilot project was initiated to provide primary health and dental care to people with a Serious Mental
Illness without health coverage. This project involves a Federally Qualified Health Center and a Community
Mental Health Center. Two other sites have been selected to further pilot this initiative.
Management Information Systems. The Information and Decision Support Services Division (IDSS) is
responsible for the management information system of the ODMHSAS. This group was recently realigned
under the lead of the Chief Information Officer (CIO). IDSS includes approximately 40 staff to organize a
robust information system that is closely integrated with service delivery, performance improvement, systems
transformation, legislative and public policy analysis and planning at local, state, and national levels.
Strategic planning specific to several of these functions is being organized through the Information
Technology Steering Committee appointed by the Commissioner and chaired by the CIO.
A key source of information is the Integrated Client Information System (ICIS) which captures demographic
and encounter data at the unique client level. All services funded in part or entirely by the ODMHSAS are
entered into this data system. ICIS data are used to generate payment information to providers through fee-for-
service (automated service invoicing) systems.
IDSS analysts extract data from ICIS and other sources, compile responses to service recipient surveys,
respond to internal and external requests for information, and support block grant and accreditation
compliance. They maintain state and national web sites and create reports and fields to support grants,
performance and outcomes assessments, and other projects. IDSS develop, implement, and assist
Department evaluations of pilot programs, federal grant initiatives, performance indicators, and other data
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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based analysis. IDSS is responsible for the Data Infrastructure Grant (DIG) and the Uniform Reporting
System (URS). These functions are closely coordinated with all Mental Health Block Grant activities. IDSS
staff is always present at Mental Health Planning and Advisory Council meetings to assist with inquiries
about data, trends, and performance improvement.
Human Resources Development and Performance Improvement. These are also key elements of the
ODMHSAS and provide essential functions to transformation and a recovery-informed system. These are
discussed in more detail as resource management features under Criterion 5 of this Plan.
Support, Advocacy, and Collaboration. Oklahoma continues to enjoy the benefits of collaboration and
active partnerships among multiple constituencies and peer state agencies. The partnerships have created
exciting opportunities for support, advocacy, and systemic improvement on behalf of Oklahomans across the
life span. Some of these are described in detail in the Adult Plan. Items specific to the needs of children and
their families are addressed in more detail throughout the remaining sections of the Children’s Plan.
The ODMHSAS’s Role and Relationship within State Government. The ODMHSAS is a distinct agency
within state government. As the single agency for mental health and substance abuse services, the
ODMHSAS participates in numerous strategic relationships with other state agencies. The ODMHSAS is
assigned within the Executive Branch of state government under the Governor’s Cabinet Secretary for
Health. The ODMHSAS, as directed by Governor Brad Henry, is also the lead agency for the
Transformation State Incentive Grant, through which Oklahoma addresses substance abuse and mental
health as aspects of overall health for the state.
Legislative Initiatives and Changes. Most Oklahoma state agencies were faced with the impact of a
reduced or no-growth revenue scenario for 2008. This continues to impact planning and presents
immediate and long-term challenges to the state. With only limited increases, the following highlights
selected legislative actions completed during the 2008 Session.
• Basically, the ODMHSAS received funding at the near identical level to that appropriated in 2007.
Although this will allow the state to continue all existing and previously funded mental health and
substance abuse services, the actual impact of level funding is yet to be seen. Service providers will
be challenged to maintain the same level of services as in previous years while balancing increased
costs in delivering those services.
• An additional $2 million was appropriated specifically for a coordinated plan in Tulsa to address
homelessness and housing needs for people with mental illness.
• Revisions were made to state law to permit broader use of telemedicine for the delivery of
psychiatric services. Amendments allow for use of this technology for initial assessments and to
redefine telemedicine as the equivalent of physical contact for purposes of psychiatric medical
services.
• The scope of the state’s suicide prevention council was amended to include suicide throughout the
lifespan as opposed to focusing only on youth.
• Several initiatives were passed that improve the operations of the ODMHSAS, including revisions to
the Commissioner’s duties (removing antiquated language), establishing an external review board to
conduct annual reviews for individuals found not guilty by reason of insanity, and adding physicians
assistants to the list of licensed mental health professionals.
• A bill passed directing the ODMHSAS to establish a Mental Health First Aid offering once available
resources are identified to support the program.
In addition, specific interim studies will be conducted to gather information and consider legislation for the
2009 session. This includes a specific study on the impacts of incarceration on women. Oklahoma has the
highest rate of female incarceration in the United States. The Mental Health Planning and Advisory Council
proposed to facilitate regional discussions to solicit input on the potential need to revise sections of Title 43A,
the state mental health statute, in order to provide clarification regarding options and protections that need to
be in place when adults are being considered for emergency orders of detention and for involuntary Civil
Commitment for treatment.
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FFY2010 Application Updates: Legislative Initiatives and Changes (2009). Oklahoma experienced
significant revenue declines in FY09, prompting the legislature to cut agency appropriations for FY2010. For
ODMHSAS, the agency received a 2% cut compared to the FY09 appropriations base. As most legislative
attention was budget related, little activity occurred related to services for people living with mental illness.
The budget environment continues to impact planning and presents immediate and long-term challenges to
the state mental health treatment system. The following list highlights related legislative changes passed in
the 2009 legislative session.
ODMHSAS was appropriated 2% less for services for FY10 than was appropriated for FY09. Adding to this
revenue challenge are unfunded mandates related to employee benefits increases amounting to an
additional 1% purchasing erosion for treatment services. The ODMHSAS approved an FY10 budget that
maintained comparable access to services for Oklahoma consumers but at the expense of access
expansions and consumer convenience. With a state revenue failure likely for FY10, the state has no margin
of error should there be additional revenue loss meaning access to services could be cut if there is no
improvement in the fiscal environment.
Statutes were revised to allow emergency detentions to occur in appropriate facilities in other state
jurisdictions if geographical criteria are met and the receiving facility voluntarily accepts the consumer.
A law was passed to allow individuals previously convicted of a felony and were under licensure (including
mental health professionals) to have better due process in the reinstatement process. This is important as
many Oklahomans who run into legal trouble due to untreated mental illness and have returned to recovery
while incarcerated or post-incarceration will have better opportunity to re-enter their chosen profession.
A bill passed clarifying medical stabilization and transportation for those in need of treatment for psychiatric
distress and experiencing a co-occurring health condition requiring general medical care.
The title of state law related to the Children's Code was rewritten, resulting in several positive changes for
children in need of mental health services and in state custody. The rewrite did contain one item related to
dispensing psychotropic meds to children without judicial consent which will require amendment next
legislative session due to the prohibitive nature of the section in legislation related to this topic. In the
interim, the parties involved have identified a temporary solution to meet the needs of affected children until
the next legislative session convenes.
FFY2011 Application Updates: Legislative Initiatives and Changes (FY2010). Most Oklahoma state
agencies were faced with significant cuts for FY11. These cuts came on the heels of a very painful FY10
that saw ODMHSAS’s infrastructure decimated by $20 million in cuts (7.5%). These cuts continue to impact
planning and present immediate and long-term challenges to the state. The budget and a few selected
legislative measures dominated legislative session in 2010.
Considering the 0.5% cut to ODMHSAS mandated by the 2010 legislative session, ODMHSAS state
appropriated funding reversed to FY06 levels. In this retreat, mental health providers experienced a
reduction in contract and service amounts. Important supportive services have been shuttered or
restructured.
The ODMHSAS was authorized to issue bonds to build a new inpatient facility in Tulsa through a 50/50
private public partnership. Construction on the 26 bed facility (estimated to cost $12 million) can begin when
$6 million in private donations are secured.
Revisions were made to state law to extend the period of emergency detention from 72 to 120 hours. This
will provide many consumers extended time to achieve competency in a structured crisis center and likely
avoid a lengthy civil commitment to a state hospital.
Statutes related to the ODMHSAS Advocate General’s office were revised to clarify roles. The Advocate
General’s office will now focus on access to services and consumer rights while the ODMHSAS Investigator
General will handle any investigations that are warranted.
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Several initiatives were passed to improve the ODMHSAS operations, including revisions to the
Commissioner’s duties (removing antiquated language) and establishing a statutorily required certification
process for Recovery Support Specialists.
Legislation passed to provide ODMHSAS greater flexibility in meeting difficult budgetary periods by removing
mandates to operate specific facilities.
A diversionary program, in partnership with the Oklahoma Department of Corrections, was passed with a
specific emphasis on meeting the needs of incarcerated women.
Other New Developments – Services Across the Lifespan
Transformation State Incentive Grant. Oklahoma is one of nine states funded through the SAMHSA
Transformation State Incentive Grant (TSIG) program. The availability of these resources and the TSIG-structure
itself continued to spawn new developments in the past year. These are highlighted
throughout this plan. Transformation activities are guided under the direction of the Governor’s
Transformation Advisory Board (GTAB) comprised of 18 members at large and the directors of ten state
agencies. The at-large members include consumers, family members, youth, legislators, advocates,
higher education, law enforcement, business, and philanthropy.
TSIG activities are organized within the framework of the Oklahoma Comprehensive Plan for Substance
Abuse and Mental Health Services. The plan was submitted to SAMHSA in October 2006 and was
based on findings documented in an extensive Needs Assessment and Resources Inventory Report,
also completed in 2006. The plan is dynamic and ever-changing but highlights in excess of forty
strategies to guide the state to achieve its vision for transformation – All Oklahomans will prosper and
achieve their personal goals in the communities of their choice.
Transformation activities are supported by the Innovation Center and are organized to provide
coordination, technical assistance, and change tools to help multiple state and local partners achieve the
vision for transformation (see www.OkInnovationCenter.org). The state’s intent is for MHBG and
transformation activities to continue to have close alignment and synergy.
FFY2011 Application Updates: Transformation State Incentive Grant (TSIG). In 2010 TSIG funds
supported continuation of recovery support training for consumers. Trainings were held within communities
statewide and in four prisons to help individuals gain skills to advocate for themselves and others while
incarcerated.
Cultural competency training for agency staff and Culture Vision were implemented in 2010. Culture Vision
is a web based tool for clinicians, accessible in real time to provide accurate information and evidence based
guidance related to ethnicity, religion, and culture. It is accessible on desktop computers to all ODMHSAS
funded providers throughout Oklahoma.
The TSIG tribal state relations workgroup developed an educational series on Cross Cultural Awareness.
This in 2010 and continue during FY11 to educate providers on the effects of historical trauma and on tribal
cultures and customs of their specific region of the state. This collaborative is a partnership between the
ODMHSAS agency staff and five of the tribal governments headquartered in Oklahoma.
Behavioral health screening within primary care as a TSIG funded initiative and partnership between the
Oklahoma State Department of Health and the University of Oklahoma, and the ODMHSAS was initiated.
Screening for developmental, social emotional and behavioral health issues occurred is now available in
primary care and hospital settings. Technical assistance and consultation by state agency staff supported
practitioners to become involved in the initiative.
Pending continued availability of TSIG funds, the Innovation Center will work with a professional agency to
develop and implement a statewide public awareness campaign to increase understanding of mental health
and substance abuse resources and the concept of recovery.
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Telemedicine. TSIG funds have supported the development of video conferencing technology. Initial
units were purchased in 2008 and deployed throughout the state as the first phase of Oklahoma’s
Telehealth Network. These initial units were placed in community mental health centers and their
satellite locations serving rural settings. The initiative is describe in more detail under Criterion 4. The
ODMHSAS expects additional people will be served as well as increased service delivery efficiencies will
results.
FFY2011 Application Updates: Telemedicine. The Oklahoma Telehealth Network (OTN) increased to
over 130 endpoints at 78 locations throughout the state in FY2010. This network has eliminated many
geographic, financial, and workforce barriers that existed within Oklahoma’s previous service delivery model.
The infrastructure created by the OTN has enabled other state agencies to increase access to care. For
example, the Oklahoma Department of Human Services now uses the OTN infrastructure to link children in
higher levels of care to their home town social workers and families. The OTN works with the Veterans
Administration to provide veteran-specific training and education to veterans and their families statewide.
The ODMHSAS and Indian Health Services collaborate and use the OTN to provide remote wound
management and behavioral health consultations, which is a priority in Indian Country. To better coordinate
primary and behavioral health care, fifteen primary care doctors, each with their own subspecialty, have
agreed to provide consultative services, via telehealth, to the CMHCs. CMHCs can now access consultants,
other providers, and conduct meetings and trainings via this technology. This significantly decreased the
cost of doing business significantly. The ODMHSAS estimates the OTN saved the state over $350,000
every quarter of FY2010. A consumer and provider survey was developed to solicit input on satisfaction
within the system. Surveys received thus far have been informally analyzed and reflect positive consumer
and provider satisfaction with the delivery of telemedicine services.
Integrated Payment and Information Systems. The ODMHSAS and the Oklahoma Health Care
Authority (OHCA), the Medicaid Authority, continue to redesign a seamless system of care for adults so
that services are recovery-informed, consumer-driven, and organized as a virtual single delivery
system. Much of this work has occurred within the Adult Recovery Collaborate (ARC) and has set the
stage to integrate the ODMHSAS and OHCA payment and data systems to benefit both children and
adults receiving publicly funded behavioral health services. The ARC Interagency Steering Committee,
which also includes the Department of Human Services, continues to work toward systems
transformations by which all public supported behavioral health services (Medicaid and ODMHSAS
funded) can be jointly managed between the two agencies under the leadership of the ODMHSAS.
Major objectives are an integrated information and payment systems to improve access and
accountability, alignment (when appropriate) of benefits between Medicaid and the ODMHSAS, and
increased consumer and family choices in services. Policy changes, Medicaid State Plan amendments,
and joint staffing of numerous initiatives are outgrowths of the Adult Recovery Collaborative. For the
coming year, it is anticipated that claims for both the ODMHSAS and the OHCA billable activities will be
processed through a single system. That is a fundamental objective of this initiative. Data sharing
agreements and other blended funding activities are underway to improve access, choices, and
effectiveness on behalf of both children and adults receiving publicly funded behavioral health services in
Oklahoma.
FFY2011 Application Updates: This initiative is now referred to as the Consolidated Claims Processing
(CCP) system and went live July 1, 2010. During FY2010 extensive testing and finalization of procedures
occurred. The ODMHSAS expects, as a result of the new system, to utilize much broader bases of data to
better monitor and plan public mental health and substance abuse services. The system can more efficiently
identify additional sources of payment for services and thereby further leverage state and federal funds for
services. Finally, the new system will be provider friendly in that enrollment, utilization, and payment are all
managed through a single point information system. It is anticipated that data reported for the FY2011
MHBG purposes will be enhanced as a result. The CCP system includes services to both adults and
children.
Medicaid Changes. In addition to the integrated systems work described above, the Oklahoma Health
Care Authority (OHCA) and partner state agencies worked closely in 2008 to expand reimbursable
services through the Medicaid program. Recent developments include seeking final approval from the
Centers for Medicare and Medicaid Services (CMS) to add Family Support and Training and Community
Recovery Support to the Medicaid reimbursement program. Medicaid (OHCA) and the ODMHSAS
continue to collaborate with providers to revise outpatient behavioral health procedures to increase
consistency between the two state agencies, synchronize documentation requirements, and economize
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on certification and accreditation costs. The legislature did not approve a budget request submitted for
residential treatment for substance abuse/integrated services in the Medicaid program. Efforts to include
this in the Medicaid program will continue in the upcoming legislative session. The Center for Medicaid
and Medicare Services (CMS) recently approved a revision to the State Plan to reimburse the
ODMSHAS-credentialed Recovery Support Specialists. Similar approval for Family Support Providers
is pending. CMS has required Oklahoma to “unbundle” Program of Assertive Community Treatment
(PACT) rates to a more traditional fee-for-separate-services approach. This necessitated close
collaboration between the OHCA and the ODMHSAS to minimize fiscal impact and assure continued
compliance with PACT model fidelity.
FFY2011 Application Updates. Medicaid. Primary work related to Medicaid for FY2010 and carrying
forward to FY2011 will be connected to the Consolidated Claims Payment System that is described
elsewhere in this application update.
Housing Policy Developments. Statewide and community stakeholder groups continue to meet to
address housing and related issues.
The Oklahoma Governor's Interagency Council on Homelessness (GICH) continues to work on
implementation of the state action plan on homelessness. One goal of this plan is to increase access
to safe, affordable, and permanent housing for homeless individuals and families and individuals and
families who are at risk of becoming homeless. The current focus of the GICH breakout committee
working on increasing access to safe and affordable housing is to develop a Statewide Housing Trust
Fund with a constant source of revenue, and assistance with developing or enhancing community/local
level planning for housing development. Over the course of the last year, this breakout committee has
been working on a Housing Trust Fund Campaign and has garnered new support for this initiative
through partnerships with local foundations.
Through Olmstead funding and Transformation State Incentive grant funds, the ODMHSAS continues to
fund a Housing Support Specialist position that was added last year. The focus of this position is to
assist with development, promotion, and support of housing initiatives. This Specialist has been
instrumental in the movement of the Housing Trust Fund initiative and is currently developing a training
curriculum on housing support services. Training will be targeted to direct service providers such as
case managers, and will focus on giving them the knowledge and skills needed to help
people successfully access and maintain safe and affordable housing.
The GICH and the ODMHSAS continue to sponsor, along with other stakeholders, a Statewide
Homeless Conference every two years. The next conference is scheduled for fall 2008 and the focus
will be "Creating Lasting Solutions." Transformation State Incentive Grant funds are utilized to assist the
GICH with development and ongoing maintenance for a GICH website. The website will serve as a
statewide website for homelessness and for people at risk of becoming homeless. An initial BETA
version has been developed and is currently in the process of being revised and finalized. It is projected
that the website will go live by January 1, 2009.
Transformation State Incentive Grant funds are approved to fund three Regional Housing Facilitators for
the ODMHSAS. Under the direction of the Director of Treatment and Recovery, the Facilitators will work
to develop, expand, and maintain the number of safe, affordable, and quality permanent housing options
for people with mental illness or co-occurring mental illness and substance abuse disorders within their
assigned regions. The ODMHSAS plans to have these positions filled by December 2008.
FFY2010 Application Updates: Updates related to the above topics as well as other developments
expected to impact service systems in FY2010 are included in both the Adult and Child plans under the
topics of “System Strengths, Needs, and Priorities.”
FFY2011 Application Updates: Housing Policy Developments. The GICH helped develop the Housing
Trust Fund Alliance, a group of volunteer stakeholders. This group and others continued the efforts to create
a Statewide Housing Trust Fund. This was the third year the groups advocated for needed legislative
language and funding to facilitate this. The proposed bill remains dormant due to lack of action. The current
focus is to identify Legislative Champions for the coming year, and garner grassroots level support to
campaign for passage of the bill. One ODMHSAS Housing Support Specialist is the as lead support staff for
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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the Housing Trust Fund Alliance. In FFY2010 she began training providers and other community
stakeholders to more effectively assist consumers with accessing and maintaining housing. At least ten
trainings were provided in FY2010.
The GICH website went live earlier in 2010. It is maintained by GICH members and the Oklahoma City
based City Rescue Mission.
ODMHSAS Regional Housing Facilitators were active FY2010 and had successes with the creation of new
units and in facilitating community partnership. These activities improved access to housing and services for
people with mental illness and their families.
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System Strengths, Needs, and Priorities
Adults
Adult Service System’s Strengths and Challenges. The following items are summarized from the Needs
Assessment and Resources Inventory Report completed in connection with the transformation activities.
Emphasis on these areas will continue through the FFY 2009-2011 Mental Health Block Grant Application
cycle. This also coincides with the timeframe for the Transformation State Incentive Grant.
Strengths (Adult System)
• Evidence of a strengths-based and recovery-oriented framework.
• The ODMHSAS state-level staff empowers providers, consumers, families, and youth by providing
technical assistance to all components of the system.
• The ODMHSAS leadership’s value on the purveyance of emerging and evidence-based practices.
• Infrastructure for the state’s Psychosocial Rehabilitation Model which emphasizes choice and
recovery in lieu of older and traditional day service programs.
• Information and data-informed performance reporting on system changes to support improvement.
• The expansion and sustainability of the ODMHSAS Office of Consumer Affairs.
• Ongoing work by statewide and local consumer and family organizations, including the Oklahoma
Mental Health Consumer Council, the National Alliance on Mental Illness-Oklahoma, and the
Depression Bipolar Support Alliance.
• Success of the Integrated Services Initiative that was initially funded by the SAMHSA Co-Occurring
State Infrastructure Grant (COSIG).
• Consumer/recipient feedback processes through perception of care surveys and strategic
stakeholder meetings.
• The Oklahoma Health Care Behavioral Health Advisory Council that brings to the table an extensive
constituency base for policy advice and systemic improvement.
• An active Coalition of Advocates works to prioritize, coordinate, and unify information and proposes
improvements through the legislative process.
Challenges (Adult System)
• The transitional nature of the current adult service system.
• The expanding unmet needs of serving older adults which is impacted by a limited interface between
the traditional ODMHSAS service system and the other aging services delivery systems.
• The system’s lack of capacity, infrastructure, and expertise to implement the full range of evidence-based
practices for adults.
• Individual consumers continue to have limited choices in the range of services, providers, and
access to non-traditional services.
• Workforce limitations in terms of the current workforce, recruiting, and retaining new workers to the
adult services system.
• Limited cultural diversity within the provider pool.
• Policies promulgated at the federal level through the Center for Medicare and Medicaid Services
(CMS) that reinforce older philosophies of a medical model versus recovery approaches are
impacting the state. Specifically, the CMS decision to require Oklahoma to “unbundle” its funding
structure for the Program of Assertive Community Treatment (PACT) is difficult to implement and
maintain program fidelity.
Additional challenges identified by advocates include difficulty with accessing services in all areas of the
state and many remaining unmet needs related to housing, transportation, and employment.
Unmet Service Needs. (Adult System) The previous section on Service Systems Strengths and Challenges
highlights these. The source of the data is the Needs Assessment and Resources Inventory Report
completed in 2006 as part of the state’s transformation initiative.
Plans to address Unmet Needs. (Adult System) As referenced earlier, the Oklahoma Comprehensive Plan
for Substance Abuse and Mental Health Services developed in 2006 as transformation activities established
a framework to address unmet needs. The plan was recently updated to reflect selected priorities. Initiatives
that will address the needs of adults are listed below.
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• Develop an anti-stigma campaign targeted for staff of state agencies.
• Train staff in Cultural Competency.
• Develop telehealth network to improve access to care for rural Oklahomans.
• Fund Consumer, Family and Youth Leadership Academies.
• Develop peer-run wellness centers.
• Fund designated FTEs to develop improved access to housing for persons with behavioral
health issues.
• Develop partnerships with Latino agencies to improve access to care for Spanish speaking
individuals with behavioral health needs.
• Provide incentives for behavioral health screenings in primary care settings.
• Develop funding for university students and researchers to conduct evaluations relevant to the
behavioral health field.
Recent Significant Achievements. (Adult System) The state’s adult-serving system continues to be
dynamic and focused on infrastructure improvements and cross-agency collaborations. Examples of
improvements noted during the past year are described below.
Veteran’s Policy Academy. Oklahoma was awarded funding to participate in a SAMHSA-sponsored
Veteran’s Policy Academy. The Academy team consists of twelve representatives of various
constituencies related to mental health, substance abuse, and veterans’ issues.
Strengths Based Case Management. The ODMHSAS and the Oklahoma Health Care Authority
(Medicaid) were able to develop a strategy to expand workforce in the area of case management
services with the development of a career ladder approach that will provide entry into this field by
providers with a wider range of educational and experiential backgrounds.
Executive Leadership Academy. Over 30 employees graduated from the first ODMSHAS Executive
Leadership Academy class in 2008. Many of those employees have already transitioned into new
management and leadership positions within the agency. Each participant was required to present a
capstone project. Project topics included, for example, veterans’ issues, “dashboard” data systems, and
linguistic and cultural competencies. The ODMHSAS Leadership Academy received the Governor’s
Award; the top honor granted as part of the Oklahoma Quality Initiative.
Program of Assertive Community Treatment (PACT). Oklahoma’s PACT program continued to
provide effective services throughout 2008. As of June 30, approximately 800 consumers were
receiving PACT services through one of the state’s 14 PACT teams in operation in 2008. One team will
transition from the full fidelity model to an intensive case management model in the coming months in
order to better balance resources and needs within the rural southern Oklahoma area. PACT is also
discussed in the plan relative to challenges facing the state as a result of CMS requiring Oklahoma to
“unbundle” Medicaid reimbursement rates.
Justice and Related Initiatives. Oklahoma has implemented multiple strategies to more effectively
address the needs of persons with mental illness and addiction disorders who are also impacted by
juvenile and adult corrections systems. Major emphasis is placed on coordination with corrections, law
enforcement, and courts. Programs are in place to provide early identification, diversion, incarceration-based
treatment, and successful community reentry. Descriptions of these programs follow.
• A highly successful jail diversion program (Tulsa) and day reporting program (Oklahoma City)
continue to operate and provide flexible community-based services to wrap services around
persons at risk of entering or returning to these metropolitan jails.
• Over 260 law enforcement personnel in approximately 23 counties have been trained in the
Memphis Model/Crisis Intervention Training or a similar law enforcement-based diversion program.
• Twelve mental health courts are in place. Two are in the major metropolitan areas and all others
are in rural communities.
• Drug courts for both adults and/or juvenile offenders are in place in 59 of 77 counties. Funding for
drug courts include resources for substance abuse as well as for co-occurring mental health
treatment.
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• Funding continued in 2008 to support four Reentry Intensive Care Coordination Teams (RICCT).
The teams are comprised of a specifically trained Intensive Case Manager and a Recovery (Peer)
Support Specialist to provide success oriented and strengths based reentry support following
incarceration.
• The ODMHSAS has provided three Discharge Planners to work within targeted prisons within the
Oklahoma system. Discharge Planners are located with prison treatment staff to identify inmates
preparing for reentry who will have ongoing mental health and substance abuse treatment needs.
Discharge Planners and the RICCT’s work closely together, along with corrections staff, and under
the direction of the ODMHSAS Director of Community Based Services.
• Three co-occurring treatment specialists, employed by the ODMHSAS, work in two state prisons
and three community correction facilities to provide co-occurring treatment to inmates identified as
in greatest need of integrated treatment for mental illness and addictions issues.
• Oklahoma is also the target site for a Medicaid reinstatement pilot project for reentering offenders.
This is funded by CMHS and coordinated through Mathmatica Policy Research, Inc. This project
has engaged staff from multiple state and federal entities to analyze and design effective
approaches to assuring immediate access to Medicaid and Social Security benefits upon
community reentry from prisons and state hospitals.
• Family members, advocates and consumers of mental health and substance abuse services are
reporting one impact of many of these initiatives is a shift within the Department of Corrections
facilities to focus more on rehabilitation, recovery, and person-center plans that will support a more
normalized return to their home communities.
Peer and Family Advocacy
• WRAP and Consumer Training. The ODMHSAS contracts with the Oklahoma Mental Health
Consumer Council (OMHCC) to continue the Wellness Recovery and Action Plan (WRAP) training.
In state FY08, over 400 consumers completed a WRAP course. OMHCC conducts an annual
consumer conference that provides intensive training for consumers and expanded opportunities
for networking with peers across the state. OMHCC has been effectively providing WRAP
in diverse settings, including jails and state prisons.
• Family-to-Family and Other NAMI-based Support Programs. The ODMHSAS contracts with
NAMI-OK to provide a variety of educational services, including Family-to-Family, Visions for
Tomorrow (VFT), Hope for Tomorrow, and Peer to Peer. In 2008 over 500 people participated in
these programs.
• Consumer Involvement Standards. Oklahoma’s TSIG evaluation will include measures, under
development, to determine the extent to which consumers are impacting individual and local
organizations as well as state-level decisions regarding mental health and substance abuse
services. A workgroup of consumers drafted and field-tested standards in 2008 to be used in this
evaluation project. Results of field-testing will be used to finalize and implement the standards as
a tool to measure and increase consumer involvement at all levels of the service system. This
model is being supported and closely followed by SAMHSA as a potential template for other
states.
• Recovery Support Specialists. The ODMHSAS continues to train and credential Recovery
(Peer) Support Specialists. At the time of this application, approximately 175 have been trained
through the ODMHSAS Office of Consumer Affairs, more than doubling the number from 2007. A
broader group of stakeholders has been engaged and revised the training and credentialing
process to expand the numbers, settings, and diversity of persons in recovery who are qualified to
provide peer recovery services. Collaboration has included constituencies from mental health,
addictions, corrections, faith-based organizations and the state Medicaid authority. Medicaid
reimbursement has been approved for this service.
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Implementation of Evidence-Based Services
• Illness Management and Recovery. During state FY08, four CMHC-based Psychosocial
Rehabilitation Programs implemented Illness Management and Recovery (IMR) as the SAMHSA
evidence-based practice. This initiative will interface with a transformation-based evaluation
project to determine the impact of IMR on consumers’ perceptions of care and outcomes.
• Supported Employment. The ODMHSAS and the Department of Rehabilitation Services (DRS)
have continued with improvements to expand supported employment as an evidence-based
practice. The DRS Milestone (provider reimbursement) mechanism for related services was jointly
evaluated by the ODMHSAS and DRS to determine its effectiveness in serving people with mental
illness. As a result, a new Milestone configuration was proposed and approved by DRS's Board to
be utilized for specialized mental health supported employment best practices contracts.
FFY2010 Application Updates:
Transformation State Incentive Grant. Substantial progress in transformation activities was made in
FFY09 to help the Oklahoma workforce gain skills needed to provide effective treatment and develop
supports within the system. Training for licensed and unlicensed staff in evidence base practice,
collaboration with universities to prepare students for work within the Department of Corrections system,
training probation and parole officers and institutional staff in recovery principles, continued expansion of
peer recovery support training, development of consumer, family and youth leadership academies, and
cultural competency training of trainers through the National Multicultural Institute to prepare staff to work
with culturally diverse consumers in Oklahoma.
In addition to staff training, some of the other initiatives underway in FFY09 include, partnering with the
Oklahoma State Department of Health, Child Guidance Division to offer training and consultation to
physicians primarily treating young children to screen for social emotional and developmental delays. TSIG
offered incentives by providing the physicians with selected tools for screening and child guidance staff at the
local level trained and offered consultation to physicians. Screening efforts within hospital emergency rooms
is also underway through a private-public partnership with several hospital systems in Oklahoma to screen
for alcohol and drug abuse. Transformation activities are supported by the Innovation Center and are
organized to provide coordination, technical assistance, and change tools to help multiple state and local
partners achieve the vision of transformation. The current implementation plan for the state may be viewed
at www.okinnovationcenter.org.
Telemedicine. Statewide infrastructure has improved to support video conferencing, telehealth, and
telecourts. ODMSAS hired a Coordinator for Telehealth. That individual provides support and strategic
development to approximately 80 teleconferencing sites funded through the ODMHSAS. The sites provide
telehealth, telecourt, and administrative meeting support through this statewide network.
Integrated Payment and Information Systems. December 1, 2009 is the targeted launch date for the
integrated payment system .
Medicaid. The Center for Medicaid and Medicare Services (CMS) recently approved a revision to the State
Plan to reimburse the ODMHSAS-credentialed Peer Recovery Support Specialists and Family Support
Providers.
Housing Policy Developments. Oklahoma will submit an application to extent Olmstead funding two
additional years. If approved, funds will be used to continue initiatives begun under the original Olmstead
grant. The grant partially funds the salaries of the Director of Treatment and Recovery and one state-level
Housing Support Specialist – both who work within the Community Based Services Division of the
ODMHSAS.
Although the Legislature has not yet approved appropriations for a Statewide Housing Trust Fund, the
Governor’s Interagency Council on Homelessness (GICH) and others are developing strategies to establish
statewide grass roots support for new state resources to support housing development.
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The Governors Transformation Advisory Board (GTAB) approved use of Transformation State Incentive
Grant (TSIG) funds for three Regional Housing Facilitators. Two of those positions are now filled – one for
the north eastern section of the state and one for the Tulsa metropolitan area. Recruitment continues for the
third Facilitator who will be based in the Oklahoma City metro area.
The Mental Health Association in Tulsa (MHAT) continued with development of a new project that will make
housing available for former residents of the Safe Haven currently located in downtown Tulsa YMCA. That
building will be eliminated as a result of developments and building in Tulsa. The new Tulsa project
employs an integrated housing approach where by the former Safe Haven residents will reside within a
larger apartment complex. Development of that complex received significant public attention during 2008
and 2009 – much of which required proactive anti-discrimination strategies on the part of the MHAT and
other leaders in the Tulsa area.
The City Rescue Mission in Oklahoma City continues to work closely with the GICH to launch a website to
support activities of the GICH. The launch is expected by January, 2010.
A Residential Care transition project was initiated for SFY 2010. This project provides the opportunity for
operators of ODMSHAS contracted residential care homes to apply for funding incentives to support
residents to transition from the ResCare settings to permanent supporting housing in the community. TSIG
and state appropriations will be used to support this. Eligible ResCares will receive additional funding as
specific milestones are achieved on behalf of specific residents who will or have transitioned to permanent
supported housing. Milestones are based on completion of intensive training of ResCare staff and residents,
on-site reviews, and housing retention – including a final payment after one year of successful housing
retention for each consumer served.
Justice and Related Initiatives. Crisis Intervention Training (CIT) continues to involve collaboration
between numerous law enforcement entities and the ODMHSAS. To date, over 500 law enforcement
personnel have been trained statewide. The ODMHSAS contracts with the Oklahoma Association of Chiefs
of Police for limited support of the CIT project, including publicizing trainings and tracking numbers of
trainees who complete the program.
In 2009, the ODMHSAS and Department of Corrections modified CIT and developed Corrections Crisis
Resolution Training (CCRT) for probation, parole, and correctional officers. Piloted trainings have been
completed and schedules are now in place to train at least 250 participants in 2010. This project is partially
supported with TSIG funds.
Mental health courts continue to expand and demonstrate efficacy. Federal stimulus funding sub granted
through the Attorney General’s Council Justice Assistance Grant Board, will allow the ODMHSAS to add
additional courts in 2010. By January 2010, fifteen courts are expected to be in operation. Mental health
court operations and expansion are closely coordinated with the statewide initiate for drug courts. Some
courts particularly focus on participants with co-occurring mental health and addiction disorders. Over 50
drug courts are also in operation throughout the state. Outcome data systems closely track the performance
of each court and the impact on persons served.
Peer and Family Advocacy. The ODMHSAS Office of Consumer Affairs was reorganized under new
leadership in FY2009 and staffed by the Director of Advocacy and Wellness. The Director of that office
coordinate much of the peer and family advocacy work that occurs in cooperation with the ODMHSAS.
ODMHSAS has contracted with NAMI to work with the Department of Corrections to develop WRAP training
and Peer Recovery Support Specialists in the prisons and Community Corrections facilities.
The Consumer and Advocacy groups have united to present a joint conference in the spring. The groups
include Oklahoma Mental Health Consumer Council (OMHCC), the National Alliance on Mental Illness
(NAMI-OK), the Depression and Bipolar Support Alliance (DBSA), Oklahoma Citizen Advocates for Recovery
and Treatment Association (OCRTA) and the State Mental Health Coalition for Aging. The theme of the
conference will focus on wellness.
Implementation of Evidenced Based Services. TSIG funded research continues to compare the recovery
outcomes for persons who participate in the Psychosocial Rehabilitation Programs (PSRs). Within the PSR
program two groups are being followed – those that receive the SAMHSA-approved Illness Management and
Recovery (IMR) and those who do not. A consumer evaluator was hired by ODMSHAS to work fulltime on
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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this project. Over 100 interviews of PSR participants have been completed, including the four sites where
IMR is incorporated in PSR programs.
Supported employment developments have not moved at the pace originally envisioned by the ODMHSAS.
Budget reductions for the Department of Rehabilitation Services (DRS) have impacted this. However, it the
new DRS Director and the ODMHSAS Commissioner have committed to utilizing the cross-agency advisory
committee to further support supported employment strategies.
Older Adults. In FY2009, Oklahoma was awarded a SAMHSA Targeted Capacity Expansion grant for Older
Adult Mental Health. The Oklahomans Learning to Direct Recovery (OLDR) program is targeting senior
citizens in two Oklahoma counties, Comanche & Ottawa, with Wraparound case management and a
Systems of Care approach to community team building. Program consultation is ongoing from Three Rivers
Community Mental Health Center in New Hampshire and from the National Association for State Mental
Health Program Directors’ Technical Assistance Center.
Transformation State Incentive Grant funds are being used to support the Oklahoma Mental Health and
Aging Coalition. Oklahoma was the first state in the nation to develop a coalition to bring together the mental
health network, the aging network, and older adult consumers to work together for the benefit of older
Oklahomans in need of mental health and substance abuse services. The TSIG funds are used to support a
full time Mental Health and Aging Coalition developer for logistical and planning support to the Coalition and
to help grow local coalitions throughout the state. The developer will also work to closely, on behalf of
Oklahoma, with the National Mental Health and Aging Coalition.
FFY2011 Application Updates:
Transformation. Updates on the Transformation State Incentive Grant (TSIG), telemedicine, the Integrated
Payment System (now the Consolidated Claims Processing system), Medicaid, Housing Policy
Developments, and Peer and Family Advocacy have been summarized in other sections of this application.
Implementation of Evidenced Based Services. In FFY2010, the ODMHSAS continued a research
project to evaluate recovery outcomes for consumers that received Illness Management and Recovery (IMR)
within selected psychiatric rehabilitation projects. The current focus is on 12- month follow-up surveys.
Both the ODMHSAS and the Oklahoma Department of Rehabilitation Services (DRS) continue to have an
interest in further expanding Supportive Employment (SE). However, efforts were further delayed in 2010
due to the economy and State agency budget reductions.
Older Adults. ODMHSAS continues to fund one full-time position at HOPE Community Services Inc. for an
older adult program and outreach coordinator. This position works to reach older adults in the community
with mental health needs and offer them behavioral health services tailored to their specific needs. This
position also works to develop support groups addressing the special needs of grandparents raising
grandchildren and community-identified needs.
FFY2010 is the final year for the SAMHSA Targeted Expansion grant for Older Adult Mental Health. The
project is on task to solidify local systems of care for older adults in the Comanche and Ottawa counties.
There is a possibility grant funding will be allowed to extend into FY2011 for completion of the project.
Transformation State Incentive Grant (TSIG) funding for the Oklahoma Mental Health and Aging Coalition
(OMHAC) will expire during SFY2011. With the TSIG funding and dedicated staff efforts, the OMHAC
developed its first local affiliate in Tulsa. Two other communities are in final preparations to formalize their
affiliates. , OMHAC is part of Aging Services Division State Plan to develop a pilot program with 4 of the 11
aging agencies in the state to provide education and advocacy and provide the tools to replicate events such
as geriatric depression screenings.
State’s Vision for the Future of the Adult System. Oklahoma’s vision for a transformed mental health and
substance abuse delivery system is that all citizens will prosper and achieve their personal goals in the
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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community of their choice. Current Commissioner Terri White frequently emphasizes to all audiences that
“Recovery is a reality in Oklahoma!” To achieve this vision, the state developed a comprehensive plan as a
roadmap for full scale transformation. Oklahoma’s transformation involves more than improving the
traditional delivery of substance abuse and mental health services. Transformation means that the general
public will understand that mental health and freedom from addiction are essential to overall health. It means
Oklahomans will acknowledge that people with mental illness and addictive disorders can and do recover
and that recovery is not age-limited. It means that mental health and substance abuse services will be
driven by consumer and family needs that focus on prevention, building resilience and facilitating recovery.
Transformation will require new attitudes, behaviors, and strategies to address long-standing deficiencies
that make change difficult. Solving these problems requires time and, most importantly, requires active,
committed, and sustained leadership.
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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System Strengths, Needs, and Priorities - continued
Children
Child Service System’s Strengths and Challenges. The following items are summarized from the Needs
Assessment and Resources Inventory Report completed in connection with the transformation activities.
Strengths (Child System)
• Substantial cross-agency collaboration and policy developments.
• Specific to the cross-agency collaboration are the resources contributed by multiple state agencies in
the form of upper level management staff to meet regularly to address, plan, and implement systemic
changes.
• Continued growth of Systems of Care (SOC) sites have carried with them values that infuse energy
and focus in all child-serving systems. The wraparound service model has been a framework to
exemplify and sustain these values.
• Oklahoma’s significant involvement with the National Child Traumatic Stress Disorder Network.
��� Growing collaboration to strengthen services to younger children and address early identification,
intervention, and early service needs.
• A strategic funding plan to expand a continuum of services and coordinate resources across all child-serving
agencies.
• Growing collaboration to address the needs of transitional age youth.
• A vibrant youth-led leadership development program for youth impacted by serious emotional
disturbance (SED).
• Initiatives beyond the ODMHSAS through the Oklahoma Department of Human Services (OKDHS)
and the Office of Juvenile Affairs (OJA) to implement evidence-based and trauma-informed programs
within these child-serving systems.
• Expansions supported by the state Medicaid authority to assure health care, including behavioral
health services, to an increased number of children and their families.
Challenges (Child System)
• Significant gaps exist between the estimated prevalence of children in need of mental health
services and the capacity of the state to respond, in spite of exemplary systemic collaboration and
improvements. The number of children eligible for services is expanding at a faster pace than the
availability of public resources.
• The lack of accessible community-based services.
• The lack of early access options for intervention and prevention for families and their children.
• The growth of non-English speaking families is disparate with the availability of linguistically matched
workforce.
• Transportation to access services preferred by families which are not available in all communities.
• Transition issues for youth as they “age out” of the child system without systemic interface with the
adult system.
Unmet Service Needs. (Child System) The previous section on Children’s Service Systems Strengths and
Challenges highlights these. The source of the data is the Needs Assessment and Resources Inventory
Report, completed in 2006 as part of the state’s transformation initiative.
Plans to Address Unmet Needs. (Child System) As referenced earlier, the Oklahoma Comprehensive Plan
for Substance Abuse and Mental Health Services, developed in 2006 as transformation activities established
a framework to address unmet needs. The plan was recently updated to reflect selected priorities.
Initiatives that will address the needs of children, youth, and families are listed below.
• Develop an anti-stigma campaign targeted for staff of state agencies.
• Develop a care coordination initiative to increase community tenure for youth with high propensity
for out-of-home placement.
• Train staff in cultural competency.
• Develop partnerships with universities for child psychiatric fellowships.
• Develop telehealth network to improve access to care for rural Oklahomans.
• Fund Consumer, Family, and Youth Leadership Academies.
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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• Develop partnerships with Latino agencies to improve access to care for Spanish speaking
individuals with behavioral health needs.
• Provide incentives for behavioral health screenings in primary care settings.
• Fund designated staff to build the Infant and Early Childhood infrastructure.
• Develop funding for university students and researchers to conduct evaluations relevant to the
behavioral health field.
Recent Significant Achievements. (Child System) Oklahoma’s well established foundation of
partnerships and shared vision among major stakeholders continues to shape and improve the overall
service delivery system for children and their families. Some are highlighted in this section.
Partnership for Children’s Behavioral Health (PCBH). This partnership continued as a proactive
force on behalf of children in 2008. The PCBH is comprised of the directors of the eight children serving
state agencies, five parents of children with serious emotional disturbance (SED), advocacy
representatives, and two state legislators continued to be active. All members were appointed by
Governor Brad Henry in response to a Memorandum of Agreement developed as part of a Children’s
Behavioral Health Policy Academy in 2003. Most members of the Partnership continue to also serve on
the Governor’s Transformation Advisory Board. Partnership members meet as a separate body as
needed to address issues specific to children, youth, and their families. Recent actions taken by the
Partnership are described below.
The PCBH approved plans for a coordinated children’s budget request for the 2008 Legislative Session.
The request was not funded due to limited state revenues. However, the Legislature and other
constituencies considered the multi-agency initiative as noteworthy and encouraged the partners to
continue similar activities and requests in the future.
Partnership members submitted a proposal to the Center for Medicare and Medicaid (CMS) to support
the development of an outpatient care coordination system for children eligible for residential care
(Alternatives to Inpatient Treatment). The proposed model was patterned after a 1915C waiver.
Although this proposal was not accepted, a care coordination project is going forward using TSIG
funding. Personnel located in OHCA, the ODMHSAS and the Oklahoma Federation of
Families/Evolution Foundation (OFF/EF) will work together to ensure the children, youth, and families
accepted into the project receive seamless services across the continuum of care, with a target of no
more than a two week gap in services after hospital discharge to the first community based service.
There will be a formal evaluation of this project conducted by the University of Oklahoma Educational
Training, Evaluation, Assessment and Measurement (E-TEAM) staff.
Collaboration continued among the Oklahoma Department of Human Services (OKDHS), Office of
Juvenile Affairs (OJA), Oklahoma Health Care Authority (OHCA), Oklahoma Commission on Children
and Youth (OCCY), National Resource Center for Youth Services (NRC), the ODMHSAS, private group
home contractors, and private hospital based providers to improve the skill set of direct care staff by
providing trauma informed training in Systematic Training to assist in the Recovery from Trauma
(START). The goal is to reduce the incidence of seclusion and restraint, provide more individualized
services to children in care, and provide group home staff with technical assistance, training, and support
through consultation services provided by the ODMHSAS and the National Resource Center for Youth
Services.
The PCBH supported the implementation of training using the curriculum developed for Family Support
Partners (providers). Fifty-five family members have been trained to date in this curriculum. Partnership
activities all assisted the Oklahoma Systems of Care state staff and the Oklahoma Federation of
Families to implement a toolkit for local community development. An update to the toolkit is planned for
fall 2008.
Expansion of the statewide Systems of Care continued to closely align with PCBH activities. There are
local Systems of Care in operation and additional communities are under development.
The OKDHS and the ODMHSAS provided leadership within the PCBH to better support transition of
youth with serious emotional disturbance from the child serving system to the adult mental health serving
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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system. The ODMHSAS funded six pilot sites statewide to provide vocational, care management, and
housing referral support to youth ages 17 – 24. Oklahoma’s application for the 2008 National Policy
Academy on Youth and Young Adults in Transition was recently selected for funding. The state intends
for this Academy to launch a more concerted effort on behalf of youth and young adults.
Federation of Families for Children’s Mental Health. The ODMHSAS continued to contract with the
Oklahoma Federation of Families/Evolution Foundation (OFF/EF), the State’s Federation affiliate, to
provide statewide advocacy and education in support of children with SED and their families. There are
currently 26 active local family groups that provide support and education as peer families. They also
advocate for specific families when needed and actively advocate for a family driven system. They have
been instrumental in the development of numerous Systems of Care communities throughout the state.
In addition, the ODMHSAS contracts with OFF/EF to provide technical assistance to the thirty- six
operational Systems of Care sites in Oklahoma, including strategic planning, community readiness, and
new site development.
Prevention and Early Intervention Activities. Suicide prevention, early childhood assessments, and
targeted activities related to infant mental health have increased. Also, Governor Brad Henry formed a
task force that subsequently formulated recommendations for more proactive approaches to address the
needs of youth and young adults in the state’s higher education community. Related to this, the
University of Central Oklahoma recently announced its commitment with the new academic year to be
Oklahoma’s first prevention-oriented campus. This proactive approach more closely and effectively
aligns behavioral health and security needs in the higher education setting.
Exemplary Treatment for Children
• The ODMHSAS Director of the Office of Children Youth and Families provides visible and broad
based representation from the ODMHSAS in numerous settings where children’s services are
discussed. This individual also serves as Principal Investigator for Oklahoma Systems of Care.
Partnerships emerging from these activities have greatly enhanced the state’s Systems of Care
activities. There are currently 36 local Systems of Care statewide. Additional communities are in a
strategic readiness/development phase, however, due to a flat budget year for Oklahoma, there
was no new funding for communities this year.
• The ODMHSAS supported training of children’s mental health workers through the Department’s
regular Donahue Series and the Annual Children’s Conference. The Children’s Conference
typically attracts 800 to 1,000 participants each year. There is a robust Oklahoma Systems of
Care annual training program coordinated through the Office of Children, Youth, and Families
(attached). Wraparound training is augmented through a statewide coaching system. This system
is headed by two full-time trainers/coaches. There is a new certification program for wraparound
facilitation. Additionally, there is a specialized curriculum for family support providers and for
behavioral health aides. Through contracts with the University of Oklahoma, ongoing training is
available to clinicians in trauma-focused cognitive behavioral therapy and Parent Child Interaction
Therapy at no charge to the clinicians.
• Since 2005, the ODMHSAS has received an annual state appropriation of $500,000 to provide
Counseling services for children and youth who have been trauma-exposed. Contracts have
been issued to eight domestic violence shelters, three CMHCs, and to the Latino Community
Development Agency. Two of these contracts are specifically targeted for Spanish-speaking
families. Trauma-focused cognitive behavioral therapy will be the central evidence-based
intervention for these services. The Women In Safe Home, Inc. (WISH) project also partners with
a CMHC, Green Country Behavioral Health to utilize Dr. Bruce Perry’s training and approach in a
therapeutic head start program.
• The legislature targeted additional funds beginning in state FY07 to increase services to children
and youth in partnership with schools and/or child care centers. Eight agencies were selected to
plan and deliver increased services to children and youth through this program. The centers are
in Ponca City, Muskogee, Oklahoma City, Tulsa, Woodward, Lawton, and the area including
Beckham, Custer, Roger Mills, and Washita Counties. National experts held one-day trainings for
program staff in Positive Behavioral Interventions and Supports (PBIS), a best practice model for
partnerships with schools.
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Transition Services. The legislature appropriated over $600,000 in state FY07 to fund an array of
services for transitional age youth, including wraparound, housing subsidy, and employment/education
assistance. Funding continues as part of the ODMHSAS base budget. Six sites were selected to initiate
programs for this age group which now includes youth ages 17 – 24. OKDHS has assigned a
representative in each region to work specifically with the youth in these programs. All programs are
receiving training in best practice, Transition to Independence Programs (TIPS) and in the wraparound
model. Training began with Dr. Rusty Clark and Dr. Nicole Deuschenes from the University of South
Florida. Housing subsidies are brokered through one CMHC but available in all transition pilot sites.
Crisis Centers. In state FY07, the legislature appropriated in excess of $1.5 million for additional
regional crisis stabilization facilities (24 hour behavioral health crisis response for children and youth,
ages 10 to 18). Two CMHCs were selected to develop the programs: Associated Centers for Therapy in
Tulsa and Green Country Behavioral Health Services in Muskogee. Unfortunately, one of the centers,
Green Country, has closed due to never building a census that would support the cost of operation.
Mobile Crisis Response (MCR) Services. The state FY07 appropriation increase also included
$850,000 for mobile crisis teams for mental health and substance abuse emergency services for children
and youth. Nine mobile crisis teams were active in state FY08, six of which were located in rural areas.
A training package has been designed to train in best practices for crisis response. The ODMHSAS also
hired an Access Specialist to monitor program start up and fidelity on an ongoing basis. Teams provide
outreach, assessments, evaluation, crisis intervention and stabilization, referral, crisis planning, 24-48
hour follow-up appointments, short term therapy, and/or monitoring for individuals experiencing a mental
health or substance abuse emergency. MCR teams respond to crises in the community, at schools,
hospitals, shelters, places of employment, and other community settings to stabilize the situation in the
youth’s natural environment. MCR services are designed to de-escalate the crisis situation, prevent
possible inpatient hospitalization, detention, homelessness, and restore youth to a pre-crisis level of
stabilization. Services are tailored to youth and their families and focus on family strengths, needs, and
preferences. While all MCR teams have the same goals and objectives, each community has their own
specifications to best meet the needs of the consumers in their communities.
FFY2010 Application Updates: Updates related to the Transformation State Incentive Grant,
Telemedicine, Integrated Payment and Information Systems, and Medicaid are included in the Adult
plan but all of these will continue to positively impact services for children and their families. Additional
transformation activities are described in the following updates.
Medicaid. The Center for Medicaid and Medicare Services (CMS) recently approved a revision to the State
Plan to reimburse the ODMHSAS-credentialed Peer Recovery Support Specialists and Family Support
Providers.
Partnership for Children’s Behavioral Health (PCBH) and Systems of Care. The PCBH continues to
work within the Governor’s Transformation Advisory Board (GTAB) and is functions as a separate group as
needed to specifically focus transformation activities on the needs of children, youth, and families. The
Systems of Care continue to grow in Oklahoma. Oklahoma completed year six of a Systems of Care grant
funded by the CMHS Comprehensive Community Mental Health Services Program for Children and Their
Families initiative. In 2009, Oklahoma was awarded an additional six-year grant to further expand systems
of care statewide and also focus on specifically underserved populations. Currently 40 counties are served
by local Systems of Care. A new project has begun with the Indian Health Care Resource Center in Tulsa in
FY09. In 2010, six additional communities will come on line. The state is on track for all 77 counties to be
served by local Systems of Care teams by 2013.
The PCBH has been the foundation and coordination stimulus for significant interagency initiatives to
enhance services to children with serious emotional disturbances and their families. Following are
examples of recent activities that will continue in 2010.
OKDHS, ODMHSAS, OSDH, and OCCY collaborated with Oklahoma Association for Infant Mental Health to
develop a program to “endorse” child care workers, educators, and mental health professionals receiving
specific training in infant mental health. Endorsement is available at four levels, beginning with child care
providers.
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DMHSAS, OSDH, and OKDHS also collaborated to provide TA and consultation to child care providers who
contact the state’s child care warm-line to facilitate early intervention among children ages birth to 5 years
old with challenging behaviors.
OHCA and OKDHS are collaborating with the OU Health Sciences Center to create specialized “medical
homes” for children in foster care and adoption.
Seven agencies participated to develop a coordinated budget request for children’s behavioral health which
was a five year plan that encompassed the spectrum from prevention, early intervention, community-based
services, all the way to inpatient and residential treatment.
The ODMHSAS utilized the SAMHSA TSIG dollars to fund a pilot project at the Neonatal Intensive Care Unit
at the University of Oklahoma Health Sciences Center to screen new mothers, provide brief intervention and
refer to further treatment when needed.
Additional initiatives within the ODMHSAS will support the agency’s intent for a broader approach to serving
children, youth and families. These included SBIRT screening in hospital emergency rooms, Mental Health
First Aid training, and improved contract language to encourage CMHCs to broaden their treatment
programs to include a more holistic approach toward wellness and recovery.
Prevention and Early Intervention Activities. Much of the work of the PCBH continues to focus on early
intervention activities to more effectively identify needs and provide services for younger children. The TSIG
also funds a position at the State Department of Health (SDOH) dedicated to infant mental health. The
ODMSHAS Prevention Division received additional grants this year to focus on elimination of underage
drinking, methamphetamine prevention, and early screening and suicide prevention activities.
FFY2011 Application Updates:
Partnership for Children’s Behavioral Health (PCBH) and Systems of Care. As referenced earlier, state
revenues were drastically diminished in 2010. This will also impact budgets for FY2011. Consequently, the
state has not been able to move forward with an expanded coordinated budget request across multiple
agencies. However, the ODMHSAS avoided what could have been devastating reductions in specific
funding for children’s behavioral health services. Stakeholders, including the Oklahoma Federation of
Families, and local communities systems of care advocated effectively with the legislature to minimize the
impact of budget reductions for mental health and other services.
Transformation Initiatives. A pilot was conducted in 2010 to determine if intensive care coordination by
phone from the Oklahoma Health Care Authority (OHCA) – the state Medicaid agency-- would improve
outcomes for children. The pilot was designed to improve coordination of care for children between inpatient
and outpatient service settings and to monitor that care coordination on behalf of the children and their
families. Data demonstrated more than adequate cost savings. Efforts are underway to sustain funding for
this beyond the pilot phase. Some of this work was initially funded through SAMHSA State Transformation
Incentive Grant (TSIG). TSIG also coordinated with the Oklahoma State Department of Health (OSDH) to
coordinate evidence based early childhood prevention and early intervention activities in 2010. .
Other Developments. Additional SAMHSA grant funds were awarded to Oklahoma in FY2010 for initiatives
included in the Partnership for Children’s Behavioral Health (PCBH)/TSIG strategic plan. The Oklahoma
Healthy Transition Initiative (OHTI) is described in a FY2011 Application Update under Criterion 3. The
Statewide System of Care Expansion grant is described in a FY2011 Application Update under Criterion 4.
Both projects are multi-year and have provided significant resources so Oklahoma can continue to improve
the range and effectiveness of services available for all children, youth, and their families. The state applied
for numerous additional Federal grants that, if awarded, will continue to support Oklahoma in 2011 and
beyond to improve services and outcomes for children needing treatment and supports.
State’s Vision for the Future of the Child System. The vision for Oklahoma’s comprehensive system to
address the needs of children with mental health and substance abuse disorders and their families is the
same as that summarized in the Adult Plan - all citizens will prosper and achieve their personal goals in the
communities of their choice. The state’s comprehensive plan addresses the entire life span, prevention, and
integration with overall health. Specific strategies to impact the needs of children and their families are
identified in that comprehensive plan. See http://www.okinnovationcenter.org.
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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State Mental Health Plan
Adult Plan �� Description of Services
Criterion 1 (Adult Plan): Comprehensive Community-Based System of Care for Adults
Fifteen publicly funded community mental health centers (CMHCs) serve the state with programs established
in approximately 70 cities and towns. Department employees operate five of the publicly funded centers in
Lawton, McAlester, Norman, Tahlequah, and Woodward. The others are private, nonprofit organizations
contracting with the Department. In addition, the Department operates the Oklahoma County Crisis
Intervention Center (OCCIC) and the Tulsa Center for Behavioral Health (TCBH). OCCIC and TCBH provide
intervention, stabilization, and referral for residents who experience mental health or substance abuse
emergencies in the Oklahoma City and Tulsa metropolitan areas. The TCBH also initiated an Integrated
Dual Diagnosis Treatment residential unit in 2004. The adult system has also expanded to proactively
support diversion from the criminal justice system. Initiatives within this realm include twelve mental health
courts, a day reporting center in Oklahoma City, jail-based screenings in both Tulsa and Oklahoma City,
statewide training in the Memphis Model CIT program, prison-based dual treatment for co-occurring mental
health and substance abuse disorders, prison-based discharge planners, and community-based Re-entry
Intensive Care Coordination Teams.
Community mental health centers served 39,545 adult clients – 63.9 % of the total clients served with
Department funding during fiscal year 2008. Children under 18 accounted for 12.7 % of mental health center
clients, while 1.5 % were older than age 65. Nearly 4,100 of community mental health center clients were
diagnosed with both a psychiatric disorder and an addiction to alcohol or other drugs.
FFY2010 Application Updates: Community mental health centers served 39,545 adult clients – 63.9 % of
the total clients served with Department funding during fiscal year 2009. Children under 18 accounted for
12.7% of mental health center clients, while 1.5% were older than age 65. Nearly 4,100 of community
mental health center clients were diagnosed with both a psychiatric disorder and an addiction to alcohol or
other drugs.
FFY2011 Application Updates: Community mental health centers served 45,816 adult clients – 85% of the
total mental health clients served with Department funding during fiscal year 2010. Children under 18 (6201)
accounted for 12% of mental health center clients, while (909) 1.7 % were older than age 65. Nearly 3,300
community mental health center clients were diagnosed with both a psychiatric disorder and an addiction to
alcohol or other drugs.
Services Available for Adults. The following sections describe the array of services available in Oklahoma
for adults. This includes a description of case management services, psychosocial rehabilitation, resources
available for housing, education and employment, access to medical, vision, dental, peer advocacy, and
family support. The state’s efforts to reduce the utilization of hospitalization are discussed.
Mental Health and Rehabilitation Services. The following basic services are provided by each CMHC.
• Crisis intervention
• Medication and psychiatric services
• Case management services
• Evaluation and treatment planning
• Counseling services
• Psychosocial rehabilitation services
Employment Services. Employment and employment assistance continues to be in high demand among
consumers and advocates. Vocational services for persons with a serious mental illness continue to
be provided at three locations. Supported Employment services are currently provided at Green Country
Community Mental Health Center, Crossroads Clubhouse and Thunderbird Clubhouse. The Department of
Rehabilitation Services (DRS) and the ODMHSAS jointly fund these programs. DRS provides funding for
supported employment, transitional employment, and job placement. The ODMHSAS funds job retention
services and basic community mental health services.
DRS utilizes a performance-based funding system paying providers for each completed step, termed
“milestones.” The largest payments are provided for job placement and ninety-day job retention. CMHCs
historically found the milestone system a challenge given limited resources to initiate programs without start-
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up funds, and the way the milestone payments were weighted. The ODMHSAS and DRS evaluated the
existing milestone system and its effectiveness in serving people with mental illness. As a result, a new
milestone configuration was proposed and approved by the DRS Board to be utilized for specialized mental
health supported employment best practices contracts.
The Interagency Coordination Committee composed of consumers, family members, direct line staff, and
CMHCs was established in 1998 to provide oversight to the interagency agreement between the ODMHSAS
and DRS. The Interagency Committee, in partnership with other community stakeholders, is currently
facilitating and monitoring implementation of the SAMHSA Evidenced Based Practice (EBP) toolkit for
Supported Employment. DRS has awarded two CMHCs start up funds as model sites for implementation
of the Supported Employment EBP, and the CMHCs should receive those funds within the next couple of
months.
Housing Services. Assuring satisfactory access to comfortable and preferred housing for adults with
mental illness continues to be a challenge to the state. This continues to be an unmet need for many adults
with mental illness and the state is challenged to identify additional resources and options for housing.
Although the needs are great and unmet, a variety of options are in place. Specialized housing for people
with mental illness are located in both urban and rural settings and are funded through the ODMHSAS,
Housing and Urban Development (HUD), public housing authorities, and private sources. Housing models
include transitional housing and permanent supported housing (both congregate and scattered site).
Although some specialized housing specifically for persons with mental illness continues to be developed
(i.e. HUD funded Section 811 and HUD SHP projects), the ODMHSAS has placed an emphasis on creating
opportunities for more integrated housing and specifically on permanent scattered site housing with available
housing support services. Some stakeholders continue to encourage the development of transitional
housing services to meet the needs of consumers whose current level of recovery would make it difficult to
have success in a supported housing model.
The ODMHSAS continues to subcontract with designated CMHCs to implement HOME Program Tenant
Based Rental Assistance (TBRA) projects to very low income persons with mental illness (including those
with zero income) in rural Oklahoma. This rental assistance serves as a bridge subsidy and is transitional in
nature; a maximum of 24 months. The goal of the project is to assist participants’ access and maintain
permanent housing while they are waiting to acquire long term subsidy like Section 8, and/or are working to
increase their income either with SSI/SSDI or employment. Program services include both rental assistance
and supportive services. The ODMHSAS has written for another HOME Program TBRA grant through the
Oklahoma Housing Finance Agency with hopes of continuing this assistance in the coming years.
All CMHCs receive flexible funds from ODMSHAS. These funds may be used to secure independent
housing for clients by paying first month rent, utilities and other initial move-in expenses, and to prevent
homelessness through short term payment of rent and utilities to help avert eviction.
The ODMHSAS also funds a Discharge Planning Housing Subsidy program to assist very low-income
individuals (age 18 and older) with mental illness or co-occurring mental illness and substance abuse
disorders who are discharging from psychiatric inpatient care, Department of Corrections, or aging out of the
foster care system, with accessing and maintaining decent and affordable housing. Participants must be
homeless or at risk of becoming homeless without rental assistance. Funds assist with rent, utility costs, and
deposits. The amount and type of assistance is based on individual income and identified need. This
subsidy is tenant based.
The ODMHSAS funds a Transition Youth Housing Subsidy program to assist very low-income individuals
(ages 17 - 24) with mental illness or co-occurring mental illness and substance abuse disorders who
participate in the employment Transitions Project. Funds are used for rent, utility costs, and deposits. The
amount and type of assistance is determined based on individual income and need. This program is also
tenant based – provided for housing selected by the program participant.
Other Housing Services. Residential care facilities (ResCares) are a major source of housing for persons
with mental illness. In FY08, 1,413 ODMHSAS clients resided in 29 ResCares, about 4.2 % of the total
population with Serious Mental Illness (SMI) served by the ODMHSAS. The ODMHSAS ResCare funding
includes an incentive structure by which homes can receive a higher rate for services if they successfully
meet criteria for designation as a Recovery Home. The criteria focus on providing residents increased
opportunities for independence, self-direction, and community integration.
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As a new initiative, the ODMHSAS will issue a Request for Proposal (RFP) in state FY09 for ResCares to
provide transition services to assist residents of ResCares with moving into permanent housing in the
community and successfully linking with community supports. Transformation Incentive Grant Funds will be
utilized to provide needed training and infrastructure building within the ResCares selected for this initiative,
and state appropriations will be used to fund the actual transition services.
Education. Some education services for adults are provided through the Department of Rehabilitation
Services supported education program. DRS funds support case management activities for individuals with
disabilities attending school. Adult basic education is also facilitated through clubhouse and general
psychosocial rehabilitation programs at the CMHCs. CMHCs and other providers advocate on behalf of
service recipients/students to secure grants, loans, and other supportive services to access educational
opportunities.
Substance Abuse Services. Ninety-one ODMHSAS-affiliated programs served 20,688 clients in state
FY08 at over 197 sites throughout the state. Approximately 10% of these clients served were under age 18.
Programs offer a range of services including assessment and referral, detoxification, outpatient counseling,
residential treatment, transitional living, and aftercare. All community mental health centers are certified as
substance abuse service providers and received both mental health and substance abuse funding to serve
persons with serious mental illness and co-occurring substance abuse disorders. Specialty substance
abuse treatment providers also collaborate with local community mental health centers for mental
health assessment and other CMHC-based services as needed by consumers. Individualized, gender and
culturally-specific substance abuse treatment was required of all providers. Consumer employment,
education, housing and other needs are assessed by substance abuse providers and case management is
provided as needed to address related issues that might otherwise lead to relapse.
Medical, Vision, and Dental Services. Case management services continue to be the link to medical,
vision, and dental services for many adult consumers. Access is more likely for Medicaid beneficiaries.
Other resources are available for the non-Medicaid population. The University of Oklahoma Health Sciences
Center (OUHSC) in Oklahoma City and the University of Oklahoma Tulsa-College of Medicine provide
indigent medical care. Increased collaboration has also developed in some areas of the state with Federally
Qualified Health Centers. Many communities rely on local resources for health care such as the Indian
Health Service, clinics, homeless clinics, county health departments, and pro bono health care providers.
Dental services are also provided in local communities through free dental clinics and pro bono providers.
Dental services are also available in the state hospitals. Community mental health centers are encouraged
to use the ODMHSAS flexible funds to purchase individual medical, vision and dental services for
consumers.
Support Services and Psychiatric Rehabilitation. All ODMHSAS-certified CMHCs must provide either
Clubhouse or a general psychiatric rehabilitation program. Clubhouse programs must also be certified by
the International Center for Clubhouse Development (ICCD). Two clubhouses (Crossroads Clubhouse and
Thunderbird Club) are currently ICCD-certified. There are currently 44 general psychiatric rehabilitation
programs across Oklahoma operated within the service regions for 15 Community Mental Health
Facilities. During state FY08, four programs became model sites and implemented the Illness Management
and Recovery (IMR) evidence based practice. In FY09 these four sites as well and other programs will
participate in a research project to compare the IMR’s effectiveness at assisting people with recovery. The
project will evaluate the impact of IMR on recovery as reported by consumers. This will be funded, as part of
the TSIG evaluation activities. The IMR Implementation Steering Committee, along with other stakeholders,
will serve as the Research Committee.
Case Management. Oklahoma views behavioral health case management as a service that is essential to
the recovery process for adults with serious mental illness. Behavioral health case manager’s help
participants develop networks of natural and formal supports/resources necessary to live in the communities.
During state FY08, behavioral health case management services totaled approximately 102,000 hours for
adults.
Case management is funded both by the ODMHSAS and the Medicaid program. The definitions differ
slightly between the two funding sources, but the basic values and purposes are identical. The ODMHSAS
continues to use the strengths based model of case management. The OHCA (Medicaid) has recently
incorporated strengths based terminology and expectations in its regulations. All case managers must
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complete a specified curriculum and examination to be eligible for reimbursement from the ODMHSAS and
the state Medicaid agency. In state FY03, statutory authority, as an official Certification, formalized this
training. By July 1, 2008, approximately 1,400 individuals had satisfied basic requirements to be Certified
Behavioral Health Case Managers. A dedicated website is available to provide access to the ODMHSAS
certification information for case managers. (See http://www.odmhsas.org/CaseMgnt.)
To increase the workforce of case managers, the ODMHSAS and the OHCA collaborated to provide multiple
entry points to becoming certified. The ODMHSAS also reorganized the training and provides options for on-line
training of specific elements as well as the ability to test at numerous locations statewide to qualify for
provisional status as reimbursable case managers. In order to increase the workforce of Certified Behavioral
Heath Case Managers, the ODMHSAS has recognized the value of potential workforce members who
have case management life experience and opened up certification to people who have completed 60
college credit hours or a high school diploma with 36 total months of experience working with persons who
have a mental illness.
Case management activities may take place in the individual’s home, community, or a facility. A Certified
Behavioral Health Case Manager, in accordance with a treatment plan developed and approved by the
service recipient and qualified staff must provide the services. Billable activities include linkage with
appropriate components of the service system, support to maintain community living skills, and contacts with
other individuals and organizations that influence the recipient’s relationship with the community, i.e., family
members, law enforcement personnel, landlords, etc.
The ODMHSAS, the Governor's Interagency Council on Homelessness, the Oklahoma Social Security
Administration, and the Oklahoma DRS Disability Determination Division continue to sponsor statewide
Social Security (SSI/SSDI) Outreach, Access and Recovery (SOAR) training. SOAR is specialized training
utilizing Stepping Stones to Recovery: A Case Manager's Training Curriculum for Assisting Adults Who are
Homeless, with Social Security Disability and Supplemental Security Income applications developed by the
U.S. Department of Health and Human Services. Nearly 500 people have received the training to date. The
ODMHSAS and Oklahoma DRS Disability Determination Division staffs serve as SOAR trainers. This
training initiative, along with other inter-agency collaborative efforts, have resulted in an increase of benefits
approval on initial application from 31% to 55% and a decrease in processing time from 132 days to 62
days.
Services for Persons with Co-Occurring Disorders/Integrated Services Initiative. The ODMHSAS has
utilized funding through the SAMHSA Cross Training Initiative, a Co-Occurring Policy Academy, and the Co-
Occurring State Incentive Grant (COSIG) to build a more robust network of treatment providers to more
effectively provide services to persons with both mental illness and substance use disorders. Funding for
that initiative will soon expire. Regardless, the products developed through this initiative will continue to
impact the service infrastructure changes to provide more effective integrated treatment services. Examples
of the results of the initiative are included below.
• An integrated assessment process that includes mental health, substance abuse, and trauma.
• Core and intermediate co-occurring disorders trainings.
• Administrative code and contract changes to specifically require and support an integrated treatment
approach.
• A revised contract format for CMHCs to more clearly support integrated treatment and braided
funding to service adults and children with co-occurring disorders.
• Twelve-step oriented peer support for person with co-occurring disorders (Double Trouble in
Recovery) on a statewide basis.
Other Activities Leading to Reduction of Hospitalization. The ODMHSAS culture embraces strengths
based and consumer centered approach which expects service providers, consumers, and their support
systems to clearly identify resources and factors needed for community success and thereby reduce the use
of hospital or other institutional-based resources. CMHCs are monitored to assure that services include
cooperative discharge planning with inpatient programs and crisis units, early response and crisis
intervention programs, and community partnerships with law enforcement. A network of crisis intervention
centers is in place to provide short term stays and stabilization in lieu of placement in inpatient facilities. The
proven models, such as Crisis Intervention Training (CIT), PACT, and newly developed Intensive Care
Coordination Teams (ICCT) are designed to provide intervention, coordinated care, and successful
community integration. Recent enhancements in terms of early intervention and transitional services on
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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behalf of persons who interface with the criminal justice system will also prevent the use of hospitalization as
well as incarceration.
FFY2010 Application Updates: Enhanced Payment System. The ODMHSAS utilized a limited funding
pool in FY2009 to develop the Enhanced Tier Payment System (ETPS) for CMHCs. Centers that met
established targets earned additional money based on their performance outcomes. For every state dollar
contributed to the ETPS, the federal government contributed approximately two additional dollars through the
Medicaid matching agreement. With federally matched funds, ODMHSAS was returned in excess of
$6,000,000 to the CMHCs for additional services. The following measures, some of which are closely
aligned with the National Outcome Measures (NOMs), were the focus of the ETPS:
Outpatient Crisis Service Follow-up within 8 Days - the number, per month, of outpatient crisis service events
that were followed-up by an outpatient non-crisis service within eight days.
Inpatient/Crisis Unit Follow-up within 7 Days - the number of inpatient/crisis service events that were
followed-up by either outpatient or housing services within seven days of referral.
Reduction in Drug Use - the number of individuals who reported a reduction in drug use/abuse use over a
seven month period.
Engagement: Four Services within 45 Days of Admission - the number of times a client received at least four
services within 45 days of the start date of an outpatient episode.
Medication Visit within 14 Days of Admission - the number of times a medication visit occurred within 14
days of each admission.
Access to Treatment - the interval between initial contact and receipt of treatment services.
Hospitalization decreased and utilization of community based services increased as a result of this initiative.
FFY2011 Application Updates: Enhanced Tiered Payment System. In coordination with the statewide
CMHC network, additional measures were designed and implemented in FY2010. Reporting and monitoring
continued. The amount of funds available for payments was decreased due to state budget shortfalls. The
additional measures are listed below.
- Improvement in CAR Domain Interpersonal
- Improvement in CAR Domain Medical/Physical
- Improvement in CAR Domain Self Care/ Basic Needs
- Inpatient/Crisis Unit Readmission within 180 Days
- Outpatient Peer Recovery Support
- Access to Treatment for Children
Criterion 2 (Adult Plan): Mental Health Epidemiology Data
Estimation Methodology. Oklahoma's estimate of prevalence of adults with a serious mental illness (SMI)
is based on federal guidelines from the Center for Mental Health Services, published March 28, 1997 (using
1990 census data). Data from two major national studies, the National Comorbidity Survey (NCS) and the
Epidemiologic Catchment Area (ECA) Study, were used to estimate the prevalence of adults with serious
mental illness. The estimated prevalence for adults with SMI is 183,366. In state FY08, the ODMHSAS
served over 31,000 adults with serious mental illness or 16.5% of the estimated SMI population.
FFY2010 Application Updates: In State FY09, the ODMHSAS served 37,393 adults with serious mental
illness or approximately 16.5% of the estimated population with SMI.
FFY2011 Application Updates: In state FY10, the ODMHSAS served 41,408 adults with serious mental
illness or 21.2% of the estimated SMI population.
Sept 2010 Updates to Oklahoma Mental Health Block Grant Application and Plan FFY2009-2011 – Submitted 09/01/2010
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Quantitative Targets for Adult Service System. Quantitative targets in terms of numbers of persons
projected to be served are detailed in the goals sections of the plan. Briefly, the state proposes to increase
the number of persons served by 6%, pending significant changes in resources, in the years encompassed
by this Plan.
Criterion 3. (not applicable to Adult Plan)
Criterion 4 (Adult Plan): Target Populations
Outreach to Adults Who are Homeless.
The table below reflects the geographic distribution of homeless individuals in Oklahoma. This information is
based on the 2006 point-in-time surveys done by each of the state’s Continuums of Care (statewide 2008
point-in-time survey data are not yet available). The estimation of homeless people with serious mental
illness is based on the number of homeless individuals who identified themselves as someone with a mental
illness during the point-in-time surveys. The numbers in the table below reflect an estimated 27% of the total
homeless population. Individuals in imminent risk of becoming homeless are not included in these data.
Geographic Regions In
Shelters
Not in
Shelters
Homeless
Population
Estimate of Homeless
Individuals with a
Serious Mental Illness
Oklahoma County* 1117 400 1517 410
Tulsa County* 568 46 614 166
Cleveland County 104 141 245 66
South West 48 ** 48 13
North West 78 145 223 60
North Central 142 36 178 48
North East * 119 238 357 96
South East 62 21 83 22
TOTALS 2238 1027 3265 881
* PATH provider locations. ** No street outreach was conducted for this region
Several initiatives are in place to identify and serve homeless individuals. Oklahoma has been awarded
PATH funds in the amount of $360,000 for state FY09. The state’s PATH programs are located in the areas
of Oklahoma with the highest numbers of people who are homeless: the two largest metropolitan areas,
Oklahoma City and Tulsa, and in the rural community of Tahlequah which is located in northeast
Oklahoma. The services provided within the PATH programs for state FY09 and the subsequent years
included in this plan will focus on intensive outreach and engagement (street, shelter, and hospital) and case
management services, including related transportation and travel. Other services will include screening and
diagnostic treatment services, habilitation and rehabilitation services, community mental health services,
including psychiatric evaluation, treatment planning and review, counseling, crisis intervention, trauma
focused treatment, pharmacological treatment, substance use treatment services, including treatment for co-occurring
mental health and substance use disorders, referral and linkages to needed health, mental health,
vocational, educational, housing services including assistance with housing security deposits, one time rental
payments, and costs associated with matching eligible homeless individuals with appropriate housing
situations.
Other Homeless Services
The Tulsa Day Center for the Homeless. This urban program provides linkages with needed mental health
and community services on behalf of adults and children who present at their site. The Day Center also
provides emergency nighttime shelter